Guy Carman

Preliminary Matters

Application to hear the hearing in private.

1. The Panel heard that matters relating to the Registrant’s health and other matters relating to his private life may be referred to during the course of the hearing as may the health of a witness. Ms Simpson, on behalf of the HCPC, referred the Panel to the HCPC’s Practice Note on ‘Conducting Hearings in Private’ which sets out the approach to be taken and submitted that it was appropriate that those parts of the hearing be held in private.

 

2. The Registrant submitted that the entirety of the hearing should be held in private. He referred to his and his family’s personal circumstances and was concerned about what his children might hear about him, and its impact on them, if this matter were held in public.

 

3. The Panel accepted the Legal Assessor’s advice and it noted Rule 10(1)(a) of the Health and Care Professions Council (Health Committee) Procedure Rules 2003 (“the Rules”) whereby matters pertaining to the health and private life of the Registrant, the complainant, any person giving evidence or of any Patient or Client should be heard in private. It had regard to the HCPC’s Practice Note with particular regard to paragraph 18 which states: “Doing so is not justified merely to save the registrant from embarrassment or to conceal facts which, on general grounds, it might be desirable to keep secret. The risk that a person’s reputation may be damaged because of a public hearing is not, of itself, sufficient reason to hear all or part of a case in private unless the Panel is satisfied that the person would suffer disproportionate damage.”

 

4. Having considered the submissions of both Ms Simpson and the Registrant, the Panel concluded that there was a public interest in these hearings being heard in public. However, it also concluded that those parts of the hearing that relate to the Registrant’s health and private life, or the health or private life of any witness, should be held in private.

 

 

 

 

Proceeding in the absence of the Registrant

 

5. The Registrant attended the hearing but indicated that he may not be able to be present throughout the entirety of the hearing. Ms Simpson therefore made an application to proceed when the Registrant was absent from the hearing.
6. The Panel had sight of an email the Registrant had sent to the HCPC dated 14 December 2025 in which he stated that, even though he will initially be attending the hearing, “I am currently employed full time and I am unable to attend the full duration of the hearing, I do not wish to apply for an adjournment at this time, and wish the panel to continue the hearing in my absence. I will however attempt to attend when my duties allow me to take part in the hearing so that I may personally reiterate my remorse and regret for my actions, and respond personally to the allegation where possible.” He confirmed to the Panel at the outset of the hearing that his position remained unchanged.
7. The Panel then went on to consider whether to proceed in the potential absence of the Registrant, pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Ms Simpson on behalf of the HCPC and those of the Registrant.
8. Ms Simpson referred the Panel to the HCPC’s practice note “Proceeding in the Absence of a Registrant”. She submitted that in view of the Registrant’s submissions, if the Registrant was absent from the hearing at any point, he would have chosen to do so voluntarily. She reminded the Panel that the Registrant was not asking for the hearing to be adjourned and that he had stated that he was content for the hearing to proceed during any absence. She reminded the Panel that there was a public interest in cases being heard expeditiously and further, that witnesses had made themselves available to give evidence, albeit remotely.
9. In conclusion, she therefore submitted that there was no unfairness or injustice in proceeding with the hearing when the Registrant was absent.
10. The Registrant confirmed his difficulties in being able to attend the entirety of this hearing. He confirmed that he was happy for the hearing to proceed in his absence if he was unable to attend at any particular time. He stated that he knew it was in his best interests to attend throughout the hearing and that any absence might be to his disadvantage. However, he stated that he will try and attend whenever possible.
11. The Panel accepted the advice of the Legal Assessor. He referred the Panel to the case of R v Jones & Hayward [2002] UKHL 5 and GMC v Adeogba and Visvardis [2016] EWCA Civ 162. He advised that the Adeogba case reminded the Panel that its primary objective is the protection of the public and the public interest and that the “fair, economical, expeditious and efficient disposal of allegations made against medical practitioners is of very real importance” and 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”. The Panel has borne in mind that “there is a burden on...all professionals subject to a regulatory regime, to engage with the regulator, both in relation to the investigation and ultimate resolution of allegations made against them. That is part of the responsibility to which they sign up when being admitted to the profession.”
12. The Panel was mindful of the need to ensure that fairness and justice were maintained when deciding whether or not to proceed in the Registrant’s absence.
13. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS Practice Note entitled “Proceeding in the Absence of a Registrant”. The Panel weighed its responsibility for public protection and the expeditious disposal of the case against the Registrant’s right to be present at the hearing.
14. In reaching its decision, the Panel took into account the following:

• The Registrant had unequivocally stated that he was content for the hearing to proceed even if he were absent from part of the hearing;
• The Registrant was not asking for an adjournment;
• There was a public interest in hearings being held expeditiously;
• A number of witnesses had attended to give evidence who would be inconvenienced if this hearing did not proceed.

 

15. Having weighed the public interest for expedition against the Registrant’s own interests, the Panel decided that the Registrant would be voluntarily absenting himself and determined that it was therefore appropriate to proceed in the Registrant’s absence should he not be in attendance at parts of the hearing and that, in the circumstances there would be no unfairness or injustice in doing so.

Application to amend the charge

16. Ms Simpson made an application to amend the heading of the Particulars simply to amend it to ensure the Registrant’s correct registration number appeared in the charge. She submitted that the proposed amendment presented no injustice to the Registrant since it did not change the scope of the allegation but was intended to merely correct a typographical error.
17. The Registrant did not object to the proposed amendment.
18. The Panel accepted the advice of the Legal Assessor and carefully considered the HCPC’s application to amend the Particulars. The Panel concluded that it would agree to the Particulars being amended as sought for the following reasons:
19. the proposed amendment did not widen the scope of the allegation, but merely ensured that the correct registration number appeared in the charge; and
20. albeit that it is not determinative of the issue, the Registrant did not object to the proposed minor amendment.

 

19. In all the circumstances, there was no likelihood of unfairness or injustice to the Registrant. The Panel therefore agreed to the proposed amendment and granted the HCPC’s application.

Proceeding on mixed allegations of misconduct and health

20. The Panel had regard to the skeleton argument provided by the HCPC dated 26 August 2025 together with the HCPC’s Practice Note: ‘Mixed Allegations’. The Practice Note states that:

 

“At a final hearing involving a mixed allegation, there will be two or more statutory grounds before the Panel:

1. The statutory ground(s) that the Panel may determine. At an HC hearing, this will be the statutory ground of health. At a CCC hearing, this will be the statutory ground(s) of misconduct, lack of competence, conviction or caution, or a finding by another body.
2. The statutory ground(s) that the Panel may not determine. At an HC hearing, this will be the statutory ground(s) of misconduct, lack of competence, conviction or caution, or a finding by another body. At a CCC hearing, this will be the statutory ground of health.
3. At the start of the hearing, the Panel should clearly identify which statutory ground(s) it may determine, and which numbered particular(s) it needs to make findings on as a result. It should make clear which statutory ground(s) it may not determine, and which numbered particular(s) it will not be making findings on as a result.
4. When making findings, the Panel must not seek to make findings on any numbered particular of allegation that do not relate to the statutory ground(s) it may determine, nor must it seek to make any finding on the statutory ground that it may not determine.”

 

21. The Panel noted that it had been constituted as a Conduct and Competence Panel to primarily hear the allegation of misconduct. It therefore concluded that any consideration of the alleged adverse health allegation be deferred until resolution of the misconduct allegation in accordance with the above Practice Note.

Background

22. The Registrant was employed by West Midlands Ambulance Service University NHS Foundation Trust from approximately 2005, and as a Paramedic from approximately 2011.

 

23. On 23 March 2023, the HCPC received a referral from Jason Wiles, Consultant Paramedic for the Trust, regarding the Registrant. Mr Wiles summarised the concern that on 27 February 2023, an empty ampoule of morphine was found at the ambulance hub and an initial fact-finding process identified discrepancies with the Registrant’s remaining controlled drugs, record keeping, and explanation when questioned.

 

24. Statements were taken from various individuals, and records reviewed. When subsequently interviewed by Mr Wiles on 12 April 2023, the Registrant admitted that he had initially fabricated a story regarding his morphine on 27 February 2023 because he had panicked about the truth coming out. He admitted to taking morphine from the Trust for a long time, more recently on every shift, and explained how he did this, and how he documented the same in patient and controlled drug records.

 

25. Separately, a student Paramedic, Ms Mitchell, reported concerns regarding the Registrant’s morphine administration and procedures during a shift on 18 February 2023. Ms Symons conducted an investigation on around 19-20 February 2023 which identified various additional discrepancies regarding the Registrant’s administration of morphine.

 

26. The Registrant was examined by an expert, Dr Pardeep Grewal, Consultant Psychiatrist, on 7 March 2024.

 

27. The Registrant emailed the solicitors for the HCPC on 14 December 2025, admitting that on several occasions he has self-administered morphine rather than ‘dooping’ the same, following administration of morphine to a patient. He requested to be removed from the HCPC register as he felt he will never be able to return to paramedic duties where he would have access to morphine.

Decision on Facts

Live evidence heard

28. The Panel heard live evidence from the following witnesses who gave evidence by videolink at the impairment stage:

 

• The Registrant; and   
• Dr Pardeep Grewal, Consultant Psychiatrist.

 

29. The Panel also had sight of a number of documentary exhibits which included, but were not limited to:

 

• Statements of Jason Wiles, Paramedic and Investigator, dated 5 January 2024 and 13 January 2025;
• Statement of Rachel Mitchell, Student Paramedic, dated 30 January 2024;
• Statement of Lucille Hobbs, Paramedic. dated 20 February 2024;
• Formal Trust Investigatory interview transcript
• Statement of Jayne Symons, Paramedic Investigator, dated 17 December 2024;
• HCPC Referral form;
• Signed consent form from the Registrant;
• The Registrant’s GP records;
• A GP’s health reference;
• Expert report of Dr Grewal dated 22 September 2024; and
• The Registrant’s statement dated 14 January 2026.

 

Panel’s Approach

30. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant did not have to prove anything and the individual particulars of the Allegation could only be found proved if the Panel was satisfied that this was the case on the balance of probabilities.

 

31. In reaching its decision, the Panel took into account the oral evidence of the HCPC witnesses, together with all of the documentary evidence provided to it, including the Registrant’s written statement and supporting document submitted by him, and the oral submissions made by Ms Simpson on behalf of the HCPC.

 

32. The Panel also accepted the advice of the Legal Assessor, which is a matter of record. When considering each Particular of the allegation, the Panel has borne in mind that the burden of proof rests on the HCPC and that allegations are found proved based on the balance of probabilities. This means that particulars will be proved if the Panel is satisfied that what is alleged is more likely than not to have happened.
33. The Panel has also had regard to the HCPC’s Practice Note on Admissions in relation to the approach to be taken and the procedural safeguards in place.

Particular 1

Particular 1a

34. At the outset of the hearing, the Registrant admitted the facts of Particular 1a. The Panel noted that the Registrant had confirmed in his email dated 14 December 2025 to the HCPC that: “I have read and understood the ‘admissions fact sheet’ and ‘practice note on admissions’ and my response to the allegation’s [sic] are summerised [sic] ” The admission made was consistent with the evidence produced to the Panel, including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023 and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025.

 

35. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.

 

36. The Panel therefore concluded that it was more likely than not that the Registrant misused controlled drugs belonging to the Trust in that the Registrant self-administered morphine as alleged.

 

37. In the circumstances, the Panel found Particular 1a proved.

Particular 1b

38. The Registrant admitted the facts of Particular 1b. The admission made was consistent with the evidence produced to the Panel, including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023 and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.

 

39. The Panel therefore concluded that it was more likely than not that the Registrant continued to work and/or drive an ambulance after self-administering morphine.

 

40. As such, the Panel found the facts of Particular 1b proved.

 

 

Particular 1c

41. The Registrant admitted the facts of Particular 1b. The admission made was consistent with the evidence produced to the Panel, including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023 and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.

 

42. The Panel therefore concluded that it was more likely than not that the Registrant made inaccurate records as to the quantity of morphine administered and/all dooped.

 

43. As such, the Panel found the facts of Particular 1c proved.

Particular 2

44. At the outset of the hearing, the Registrant admitted the facts of Particular 2. The admission made was consistent with the evidence produced to the Panel including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023, and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.

 

45. The Panel therefore concluded that it was more likely than not that the Registrant reported to doop 5ml of morphine sulphate when he knew that this was 5ml of sodium chloride.

 

46. The Panel therefore found the facts of Particular 2 proved.

Particular 3

47. At the outset of the hearing, the Registrant admitted the facts of Particular 3. The admission made was consistent with the evidence produced to the Panel including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023 and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.
48. In the circumstances, the Panel therefore found the facts of Particular 3 proved.

Particular 4

Particular 4a: Dishonesty in relation to Particular 1a

 

49. The Panel, having found the facts of Particular 1a proved, then considered whether the Registrant’s conduct was dishonest.

 

50. The Registrant admitted the facts of Particular 4a. The admission made was consistent with the evidence produced to the Panel, including the admissions made by the Registrant during his formal investigatory interview with his employer in April 2023 and in his ‘statement of admission’ contained in his email to the HCPC dated 14 December 2025.

 

51. The Registrant having previously been informed of the legal test for dishonesty by the Legal Assessor in the presence of Ms Simpson, the Panel was satisfied that the Registrant understood the test as set out in Ivey v Genting Casinos (UK) Ltd t/a Crockfords [2017] UKSC 67, namely:

 

“When dishonesty is in question the fact-finding tribunal must first ascertain subjectively the actual state of the individual’s knowledge or belief as to the facts. The reasonableness or otherwise of his belief is a matter of evidence (often in practice determinative) going to whether he held the belief, but it is not an additional requirement that his belief must be reasonable; the question is whether it is genuinely held. When once his actual state of mind as to knowledge or belief as to facts is established, the question whether his conduct was honest or dishonest is to be determined by the fact-finder by applying the objective standards of ordinary decent people. There is no requirement that the defendant must appreciate that what he has done is, by those standards, dishonest.”

 

52. In the circumstances, the Panel was satisfied that the Registrant’s admission was unequivocal and that the admission was not being made for reasons of expediency or for some other inappropriate basis.

 

53. The Panel therefore concluded that it was more likely than not that the Registrant was dishonest as alleged.

 

54. The Panel therefore found the facts of Particular 4a proved.

 

Particular 4b: Dishonesty in relation to Particulars 1c, 2 and 3

 

55. The Panel, having found the facts of Particulars 1c, 2 and 3 proved, then considered whether the Registrant’s conduct was dishonest.

 

56. The Registrant admitted the facts of Particular 4b in its entirety. For the reasons set out in relation to Particular 4a, the Panel accepted the Registrant’s admissions of dishonest conduct in relation to Particulars 1c, 2 and 3.

 

57. In light of the Registrant’s admission, the Panel therefore concluded that in relation to this Particular, the Registrant acted dishonestly. The Panel therefore found Particular 4b proved in respect of Particulars 1c, 2 and 3.

 

Particular 5

 

58. Given that the Panel at this stage was only considering the statutory ground of misconduct and its underlying particulars, this Particular was not put to the Registrant at this stage.

Decision on Grounds

59. The Registrant and Dr Grewal both gave live evidence by videolink.

 

60. In his live evidence, the Registrant stated that he had been a Paramedic for some 20 years without any previous concerns being raised about his practice. He gave the Panel details of his difficult personal circumstances at around the time of the Covid pandemic. This included repeatedly working under great pressure for approximately 100 hours a week, without what he considered to be adequate support from managers, with whom he said he raised his concerns.

 

61. He said that it was at about that time that he started using morphine and that he knew that what he was doing was reckless and wrong, and that he had lost his moral stance. He stated that he wished he could turn the clock back. He accepted that his conduct, for which he was truly sorry, was ‘abhorrent’. He said that he was disgusted with himself and that he now just wanted to move on.

 

62. He said that he had not misused opiates since he left the Ambulance Service in February 2023. So far as current alcohol consumption was concerned, he said that he was not teetotal, but drank a limited amount socially, often going weeks without drinking alcohol.

 

63. He accepted in response to questions put to him by Ms Simpson, that if he were to return to practise as a Paramedic, with access to morphine, he would be concerned that the temptation to relapse would be ‘too great’.
64. In his ‘statement of admissions’ included in his email to the HCPC dated 14 December 2025, the Registrant stated:

 

[REDACTED]

 

65. The Registrant also provided an additional statement dated 14 January 2026 in which he stated:

 

“As a paramedic, I am experienced at reflective practice, and as such, I recognised that my behaviour was far short of the HCPC’s standards when I was first referred to the council, and as such recognise that I do not want to risk being placed under simular contining [sic] pressures, which had previously caused me to break down in tears to my managers who where [sic] unable to offer any support and in fact sent me back out on 999 calls.

[REDACTED]

 

66. Dr Grewal also gave live evidence. He referred to his report in which he concluded that:

[REDACTED]

 

HCPC submissions

67. Ms Simpson submitted that the Registrant’s conduct marked a serious departure from the standards expected of a registered Paramedic and was sufficiently serious to amount to misconduct.

 

68. Ms Simpson invited the Panel to conclude that the Registrant had breached standards 1, 1.1, 6, 6.1-6.3, 9, 9.1, 10 and 10.1 of the HCPC “Standards of conduct, performance and ethics” (2016):

 

Standard 1: Promote and protect the interests of service users and carers

Treat service users and carers with respect

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

 

Standard 6: Manage risk

Identify and minimise risk

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

6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.

 

Manage your health

6.3 You must make changes to how you practise, or stop practising, if your physical or mental health may affect your performance or judgement, or put others at risk for any other reason.

Standard 9: Be honest and trustworthy;

Standard 9.1: You must make sure that your conduct justifies the public’s trust and confidence in you and your profession;

 

Standard 10: Keep records of your work

Standard 10.1:You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.

 

69. In relation to impairment, Ms Simpson invited the Panel to consider the seriousness of the Registrant’s failings, and alleged ongoing risk to patients which the Registrant had accepted in his evidence, and which Dr Grewal identified.

 

70. Ms Simpson accepted that the Registrant had demonstrated insight into his conduct and health.

 

71. She submitted that, given the seriousness of the Registrant’s failings, a failure to make a finding of impairment would undermine confidence in the profession and the regulatory process.

 

72. In the circumstances, Ms Simpson submitted that the Registrant’s fitness to practise is impaired on both the personal and public components of impairment.

Registrant’s submissions

73. In his closing submissions, the Registrant conceded that his fitness to practise is currently impaired and did not seek to contradict Ms Simpson’s submissions.

 

Decision on grounds

 

Health

 

74. As the Panel was sitting as a Conduct and Competence Committee, the statutory ground of ‘health’ was not considered at this stage.

 

Misconduct

 

75. The Panel went on to consider whether the Registrant’s conduct as found proved at Particulars 1, 2, 3 and 4 amounted to misconduct. It took into account all the evidence received together with the submissions made by Ms Simpson on behalf of the HCPC and those made by the Registrant.

 

76. In considering this matter, the Panel exercised its own judgement. The Panel also took into account the public interest, which includes protection of the public, maintenance of public confidence in the profession, and the declaring and upholding of proper standards of conduct and behaviour.

 

77. When considering whether the facts found proved amounted to misconduct, the Panel noted that not all breaches of the HCPC’s “Standards of performance, conduct and ethics” need amount to a finding of misconduct.

 

78. The Panel heard and accepted the advice of the Legal Assessorwho reminded the Panel of the meaning prescribed to misconduct in the case of Roylance v General Medical Council (No 2) [2000] 1 A.C. 311, in which it was said:

 

“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 … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

 

79. In Nandi v GMC [2004] EWHC 2317 (Admin) the Court referred to Roylance where the Court described misconduct as “a falling short by omission or commission of the standards of conduct expected among medical practitioners, and such falling short must be serious” such that it would be “regarded as deplorable by fellow practitioners”.

 

80. The Panel adopted a two-step process in its consideration. Firstly, the Panel considered whether the facts found proved amounted to misconduct. Secondly, and only if the facts proved were found to amount to misconduct, the Panel would go on to consider whether the Registrant’s fitness to practise is currently impaired as a result of that misconduct.

 

81. Given the Panel’s findings in relation to the facts found proved, it concluded that the Registrant breached standards 6.1, 6.2, 6.3, 9.1 and 10.1 of the HCPC’s “Standards of conduct, performance and ethics” (2016).

 

82. However, the Panel was mindful that a finding of misconduct did not necessarily follow as a result.

 

83. Whilst not determinative of the issue, the Panel noted that the Registrant accepted in his statement of admission dated 14 December 2025 that: “I recognise that this behaviour falls extremely short of the public expectations” and in his statement dated 14 January 2026, he accepted that his conduct fell “far short of the HCPC’s standards”.

 

84. The Panel carefully considered the seriousness of the Registrant’s failings. In doing so, it identified that:

 

• the Registrant’s dishonest conduct related to misusing controlled drugs over a significant period of time;
• his conduct posed a significant risk to patient care by continuing to work/drive an ambulance after self-administering morphine; and
• the Registrant dishonestly falsified records of morphine administered and a report to conceal his misuse of controlled drugs.

 

85. The Panel heard and accepted the advice received from the Legal Assessor. Having done so and for the reasons set out above, the Panel concluded that the matters found proved and subsequent breaches of the HCPC’s “Standards of conduct, performance and ethics”, were both individually and collectively sufficiently serious departures from the standards expected of a Paramedic as to amount to misconduct.

 

86. The Panel therefore found that the Registrant’s conduct as found proved amounted to misconduct.

 

Decision on Impairment

 

87. The Panel went on to decide whether, as a result of his misconduct, the Registrant’s fitness to practise is currently impaired.

 

88. The Panel had regard to all of the evidence presented in this case, including the submissions of Ms Simpson and those of the Registrant. The Panel also heard and accepted the advice of the Legal Assessor and took into account the HCPTS Practice Note on “Fitness to Practise ‘Impairment’”.

 

89. In reaching its decision on impairment, the Panel was mindful that it does not necessarily follow that a finding of current impairment follows from a finding of dishonesty. However, any instance of dishonesty is likely to impair a registrant’s fitness to practise and it will be unusual where this is not found to be the case.

 

90. Paramedics are expected at all times to act in a professional manner. They must make sure that their conduct at all times justifies both service users’ and the public’s trust in the profession. In this regard, the Panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision. In paragraph 74, she said:

 

“In determining whether a practitioner’s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

 

91. In considering impairment, Mrs Justice Cox went on to say:

 

“Do our findings of fact in respect of the doctor’s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he:

 

1. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or

 

1. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or

 

1. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or

 

1. has in the past acted dishonestly and/or is liable to act dishonestly in the future”.

 

92. Given its findings regarding ‘seriousness’ in relation to its decision on misconduct, the Panel concluded that limbs a, b, c, and d were all engaged by the Registrant’s conduct. The Panel had regard to the fact that honesty is a core value of the Paramedic profession which the Registrant had repeatedly breached over a significant period of time.

 

93. The Panel has also taken into account the fact that the Registrant has unequivocally stated that he no longer wishes to practise as a Paramedic. However, the Panel has also taken into account the case of GOC v Clarke [2018] EWCA Civ 1463. It concluded that the correct approach was to consider whether a practitioner is fit to practise unrestricted, rather than a deliberation of whether, because of retirement, there is any likelihood of a return to practise and, thereby any risk occasioned by that. As the court observed "a person could hardly claim to be a fit person to practise…because he had no intention of doing so". As such, the Panel concluded that his stated intention not to return to practise as a Paramedic did not obviate the need for a finding of current impairment.

 

94. The Panel, having considered the Registrant’s early admissions to the facts, his written statements of admissions and his live evidence, was satisfied that the Registrant had reflected on, and demonstrated genuine significant insight into his health and misconduct.

 

95. In relation to dishonesty, the Panel recognised that dishonesty is difficult to remediate. The Panel noted that the Registrant had taken some steps towards addressing his health issues.

 

96. He accepted that if he were put in such a position, he would pose a danger to himself and others. He also accepted, as set out in his statement dated 14 January 2026, that he was “still struggling to cope on a daily basis”

 

97. The Panel also had regard to the evidence of Dr Grewal noting his conclusion that there remained an ongoing risk (which the Registrant accepted), and that the Registrant’s fitness to practise is impaired.

 

98. Whilst it was not determinative of impairment, the Panel also noted that the Registrant accepted that his fitness to practise is currently impaired.

 

99. In all the circumstances, the Panel concluded that there remained an ongoing risk of the Registrant misappropriating controlled drugs and associated dishonest behaviour. As such, the Panel determined that the Registrant’s fitness to practise is currently impaired on the personal component.

 

100. The Panel also took into account the overarching objectives of the HCPC to protect, promote, and maintain the health, safety, and wellbeing of the public and patients, and to uphold and protect the wider public interest, which includes promoting and maintaining public confidence in the Paramedic profession and upholding proper professional standards for members of the profession. The Panel therefore considered that, given the serious nature of the Registrant’s misconduct that had yet to be fully remediated, which included a deliberate and prolonged period of misappropriation of controlled drugs and dishonesty intended to conceal it, public confidence in the profession would be undermined if a finding of impairment were not made in all the circumstances.

 

101. Having regard to all of the above, the Panel found that by reason of his misconduct, the Registrant’s fitness to practise is also currently impaired on the public component of impairment.

 

Sanction

 

HCPC’s submissions

 

102. Ms Simpson referred to the HCPC’s Sanctions Policy, March 2019 (“SP”) and set out the approach to be adopted by the Panel. Having discounted lesser sanctions, she submitted that the only appropriate and proportionate sanction to impose was a striking-off order.

 

103. She identified a number of potential aggravating and mitigating factors. By way of aggravating factors, she submitted that the Registrant’s dishonesty was at the higher end of the seriousness of dishonesty. The Registrant’s dishonesty took place over a prolonged period of time and posed a significant risk of harm to the public. In addition, the Registrant submitted false information to cover up his misappropriation of controlled drugs.

 

104. By way of mitigating factors, Ms Simpson reminded the Panel that the Registrant had made early admissions to the facts alleged, and that the Registrant’s conduct should be seen in the context of his personal circumstances at the time. She also reminded the Panel that the Registrant had expressed regret and remorse for his conduct for which he had apologised, and that he had demonstrated a level of insight.

 

Registrant’s submissions

 

105. The Registrant made no specific submissions on sanction, but he had repeatedly and unequivocally said in his correspondence to the HCPC and throughout the course of this hearing, that he no longer wished to practise as a Paramedic and that he wanted to be removed from the register.

 

Decision on Sanction

 

106. The Panel accepted the advice of the Legal Assessor who referred it to the SP. He reminded the Panel that it should consider each sanction in turn in ascending order, and apply the least restrictive sanction necessary to protect the public and the public interest. It should also consider any aggravating and mitigating factors and bear in mind the principle of proportionality. He reminded the Panel that the primary purpose of imposing a sanction was protection of the public and the public interest and that there was a need to balance those interests with the interests of the Registrant.

 

107. In reaching its decision on whether to impose a sanction, and if so, which one, the Panel reminded itself of its conclusions in relation to the seriousness of the Registrant’s misconduct as set out in its determination on impairment. The Panel has concluded that the Registrant continues to pose an ongoing risk to the public, and that there remains a risk of repetition of his misconduct. As such, any sanction should reflect the need to uphold the public interest and mark the seriousness of the misconduct found proved. In that regard, the Panel had due regard to paragraphs 56-58 of the SP, noting the impact of dishonesty on public confidence.

 

108. The Panel considered all the information before it. In doing so, the Panel identified the following aggravating factors:

 

• That the Registrant repeatedly behaved dishonestly over a period of approximately a year and a half, including attempts to conceal his misappropriation of controlled drugs which included falsifying documentation;
• The Registrant had repeatedly used controlled drugs intended for service users;
• The Registrant’s actions posed a serious risk of harm to patients and the public, by both driving an ambulance and continuing to work when he had misappropriated and self-administered controlled drugs; and
• The Registrant’s dishonesty was deliberate, and for which he was solely responsible.

 

109. The Panel identified the following mitigating factors:

 

• The Registrant made early admissions both prior to and during this hearing, in which he has positively engaged;
• He has expressed significant insight into, and remorse for the issues he faces;
• Whilst the Panel has found that there remains an ongoing risk of the Registrant repeating his misconduct, the Panel noted that he has taken a number of positive steps, as outlined above,
• The Registrant does not have any previous regulatory findings recorded against him.

 

110. The Panel concluded that in all the circumstances, taking into account the significant aggravating factors identified, the Registrant’s misconduct was of such seriousness which placed it at the higher end of the scale of seriousness, and undoubtedly undermines public confidence in the profession.

 

111. The Panel approached the issue of sanction starting with the least restrictive first, bearing in mind the need for proportionality and the need 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 given the ongoing risks identified. Such an outcome was therefore neither appropriate nor proportionate in the circumstances.

 

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

 

113. 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 Panel considered that there remained an ongoing risk of repetition given; and
• Given that nature of such a sanction the public interest would not be met as imposing a Caution Order would not restrict the Registrant’s practice.

 

114. The Panel next considered whether a Conditions of Practice Order was appropriate. It had regard to paragraphs 105-109 of the SP. Notwithstanding that such an outcome might be considered appropriate to address a registrant’s clinical failings, it has concluded that such a sanction would neither be appropriate nor proportionate to address the public interest concerns identified. However, the Panel concluded that workable and appropriate conditions could not be formulated that would meaningfully address the dishonesty concerns identified. In addition, the Panel had concerns regarding whether such an outcome was workable or practicable, or that the Registrant would be willing to comply with any conditions, given that he had repeatedly and unequivocally stated that he did not want to return to practise as a Paramedic.

 

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

 

116. The Panel next considered the sanction of suspension. It had regard to paragraph 121 of the SP. 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, the Registrant had insight and that the issues were unlikely to be repeated.

 

117. In reaching its decision, the Panel was also mindful that such an outcome would serve little purpose. Whilst a period of suspension might give the Registrant the opportunity to address his health issues and his dishonest conduct with a view to satisfying a review panel that he was fit to return to unrestricted practice, the Registrant had clearly stated that “In summary, I no longer want to be registered as a Paramedic, nor work in the health care sector again, and for the safety of the public that I was once proud to support. As such, I would ask this panel to remove my name from the registration list.”

 

118. In all the circumstances, and notwithstanding the Registrant’s insight, given the seriousness of the identified aggravating factors, together with the significant risk of repetition of the Registrant’s misconduct, the Panel concluded that the imposition of a Suspension Order was neither the appropriate nor proportionate sanction to impose.

 

119. The Panel therefore considered whether a striking-off order was appropriate and in doing so, took account of paragraphs 130 – 132 of SP. Notwithstanding that the Panel had recognised that the Registrant had demonstrated significant insight into his conduct, the Panel nevertheless concluded that in order to protect the public and the public interest, any sanction less than a striking off order would not be appropriate. The Panel determined that given the nature and gravity of the matters found proved, which related to dishonesty and ongoing risk to service users, a lesser sanction would lack the necessary deterrent effect, and would undermine public confidence in the profession and the regulatory process.

 

120. The Panel therefore concluded that, in light of the Registrant’s serious, persistent and deliberate dishonesty which posed a risk of serious harm to the public and service users, a striking-off order was the appropriate sanction to impose.

 

121. The Panel has considered the Registrant’s interests, noting his settled intention to leave the profession. However, in light of its findings, the Panel considered that the need to protect the public and the public interest by sending a clear message upholding and declaring proper standards of conduct and behaviour, was paramount.

 

122. The Panel accordingly determined to impose a Striking-Off Order.

 

123. That being the case, in line with the Practice Note on Mixed Allegations, the Panel has not gone on to consider Particular 5 or the statutory ground of health.

ORDER:

That the Registrar is directed to strike the name of Mr Guy Carman from the Register with effect from the date this order comes into effect.

Interim Order

 

1. Having accepted the advice of the Legal Assessor, the Panel decided that it was fair and appropriate to proceed and hear the application in the absence of the Registrant. The Registrant was present for the entirety of the hearing up until the Panel handed down its decision on sanction, at which point, the Registrant stated that due to work commitments, he would not be able to be present for the rest of the day’s hearing.

 

2. Prior to retiring to consider its decision on sanction, the Registrant was informed that, depending on the sanction imposed, an interim order may be sought by the HCPC. The Registrant was informed of the nature and purpose of such an application. Having done so, the Registrant confirmed that he would not have any submissions to make.

 

3. That being the case, the Panel concluded that it was in the public interest to proceed in the Registrant’s absence and that there was no unfairness or injustice to the Registrant in doing so for the same reasons as set out in its earlier determination on proceeding in absence if the Registrant was unable to attend any part of the hearing.

 

4. Ms Simpson applied for an Interim Suspension Order in light of the Panel’s findings on the grounds that it was necessary for the protection of the public, and was otherwise in the public interest, to cover the appeal period for the same reasons for imposing its substantive sanction.

 

5. No submissions have been received by or on behalf of the Registrant.

 

6. The Panel was mindful that when a substantive sanction is imposed, a Registrant’s entitlement to practise is unrestricted whilst their appeal rights against the substantive sanction remain outstanding. The Panel concluded that in view of its determination that a Striking-Off Order should be imposed, it would not be appropriate for the Registrant to return to unrestricted practice given the ongoing risks identified.

 

7. The Panel therefore decided to impose an interim order under Article 31(2) of the Health Professions Order 2001, it being necessary to protect members of the public, being otherwise in the public interest, and in the Registrant’s own interests given his accepted concerns about being exposed to controlled drugs if he were free to practise as a Paramedic.

 

8. It first considered an Interim Conditions of Practice Order. The Panel concluded that such an interim order would not be appropriate given its rationale for its earlier determination on sanction. It considered that in light of that determination, an Interim Suspension Order is necessary for protection of the public, is otherwise in the public interest, and is in the Registrant’s interests. It would be wholly incompatible with the Panel’s findings and its decision as to sanction not to impose an Interim Suspension Order.

 

9. The Panel concluded that the appropriate length of the Interim Suspension Order should be 18 months, as the interim order would continue to be required pending the resolution of an appeal in the event that the Registrant submits a Notice of Appeal within the 28-day period. This Interim Suspension 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) on the final determination of that appeal, subject to a maximum period of 18 months.

 

 

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 Guy Carman

Date	Panel	Hearing type	Outcomes / Status
12/01/2026	Conduct and Competence Committee	Final Hearing	Struck off
01/10/2025	Conduct and Competence Committee	Interim Order Review	Interim Suspension
27/06/2025	Investigating Committee	Interim Order Review	Interim Suspension
10/03/2025	Investigating Committee	Interim Order Review	Interim Suspension
25/09/2024	Investigating Committee	Interim Order Review	Interim Suspension
13/06/2024	Investigating Committee	Interim Order Review	Interim Suspension
06/03/2024	Investigating Committee	Interim Order Review	Interim Suspension
14/12/2023	Investigating Committee	Interim Order Review	Interim Suspension
07/11/2023	Investigating Committee	Interim Order Review	Adjourned
04/05/2023	Investigating Committee	Interim Order Application	Interim Suspension