James Green

Preliminary Matters

Service

1.    The Notice of Hearing was sent to the Registrant, by email, to his registered email address on 1 May 2026 informing him that there would be a hearing today to review the Suspension Order which had been imposed on him on 25 February 2026.  

2.    The Notice confirmed the date and time for the hearing, and that it would take place on the virtually via Microsoft Teams.    

3.    The Notice informed the Registrant that he did not have to attend the hearing, but that it would generally be in his best interests to do so and make submissions, and to provide the panel with any new information since the last hearing.     

4.    A Certificate of Service has been provided. Service is effected by proof of sending rather than proof of receipt, however the panel was also satisfied that the emails had been delivered, as it was also provided with a proof of email delivery receipt.  The Panel also had sight of an email from the Registrant dated 26 May 2026 in which he stated he would not be attending the hearing or providing any evidence.

5.    Decision: The Panel was satisfied that service had been effected in accordance with (Rule 3 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003) and the Practice Note on Service of Documents, and that 28 days’ notice had been provided in accordance with Rule 6(2) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003.
 
Proceed in Absence

6.    The Registrant had confirmed, via email dated 26 May 2026, that he did not intend to attend the hearing or provide any evidence for the Panel to consider.  Ms Khorassani on behalf of the HCPC applied for the matter to be heard in the absence of the Registrant and directed the Panel’s attention to Rule 11 of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 which provides a power for the Panel to continue in the Registrant’s absence, and submitted that the order must be reviewed before it expires on 25 June 2026.  

7.    The Panel received legal advice.  

8.    The Panel noted that the Registrant had been properly served with the Notice of Hearing, had been made aware of today’s hearing and its purpose, and had been informed that it may proceed in his absence if he chose not to attend.  He had been invited to provide submissions and evidence but had not done so.  The Panel further noted that the Registrant had not attended the hearing on 25 February 2026 at which the suspension order had been imposed.

9.    In accordance with the HCPTS Practice Note on ‘Proceeding in the Absence of the Registrant,’ the Panel considered that the Registrant had voluntarily absented himself.  The Panel considered, taking into account the fact that he had confirmed he would not be attending today or providing evidence, that it was highly unlikely that the Registrant would attend any adjourned hearing, and that an adjournment would therefore serve no purpose.

10.    The Panel determined that it was clearly in the interests of the public for the hearing to proceed today, particularly in light of the need for the order to be reviewed before it expires on 25 June.

Review of Suspension Order

Background

11.    The Panel had access to a 22-page bundle which contained the previous panel’s decision of 25 February 2026, service documentation, and correspondence with the Registrant.  The Panel was also provided with an unredacted service bundle, a copy of the consent order made on 25 February 2026, and some recent emails with the Registrant regarding his current position and intentions to return to work as a paramedic.

12.    The background to today’s hearing was summarised by Ms Khorassani on behalf of the HCPC and also summarised within the previous panel’s decision.

13.    The Registrant is a registered Paramedic and was previously employed by Northwest Ambulance Service Central Manchester Sector (the Trust).  On 25 February 2026, the Conduct and Competence Committee met to consider the following particulars which were alleged against the Registrant:

As a registered Paramedic (PA46747):

1.    On 13 October 2020, you did not provide adequate pain relief to Service User B.

2.    On 17 May 2021:

a.    You recorded a false blood pressure reading on Service User A’s record.
b.    You did not check the blood pressure reading for Service User A, taken by Colleague A, prior to administering morphine.
c.    You did not take an accurate blood pressure reading for Service User A prior to administering morphine.
d.    You informed Colleague A that the recorded blood pressure reading for Service User A was taken after the administration of morphine, which was not the case.

3.    Your conduct in relation to particular 3a and/or 3d was dishonest in that:

a.    You knew that the reading you had recorded was not based on an actual blood pressure reading for Service User A; and/or
b.    In doing so, you sought to conceal the fact that you had not taken Service User A’s blood pressure prior to the administration of morphine.

4.    The matters set out at particulars 2, 3 and/or 4 constitute misconduct.

5.    By reason of the above matters your fitness to practise is impaired by reason of misconduct and/or lack of competence.

14. Ms Khorassani on behalf of the HCPC accepted that the above particulars contained typos, and that it was in fact particulars 2a and 2d which were alleged to be dishonest (particular 3), and that particular 4 should have referred to particulars 1, 2 and 3.  

15.The Registrant had self-referred to the HCPC on 7 June 2021 in relation to the incident on 17 May 2021, after he had disclosed to his employer that he had administered morphine to a 17-year-old patient without checking her blood pressure. The Registrant falsely documented 110 systolic on the Patient Report Form (“PRF”), and when confronted by a colleague, he crossed out the false information before submitting the PRF.  The Registrant had notified his line manager, and restrictions had been placed on his practice on 26 May 2021.  He had been administered with a 12 month first written warning by the Trust on 16 June 2021 and an action plan had been implemented.

16. On 9 August 2021, the Trust informed the HCPC that there had been a previous incident on 13 October 2020. It was alleged that the Registrant had failed to give adequate pain relief to Service User B, who was experiencing severe abdominal pain and had a pain score of 10/10. The Registrant gave Service User B 1g of oral paracetamol and elected not to give any increased pain relief to Service User B. The allegation was upheld by the Trust, and the Registrant was asked to write a clinical reflection, and a support plan was put in place.

17. On 14 October 2021, a Performance Stage 2 Hearing was held, and it was suggested that the Registrant reflect on his suitability as a Paramedic. On 26 October 2021, the Registrant requested to change roles to an Emergency Medical Technician 1 (EMT) and on 1 December 2021 had commenced work as an EMT in the Liverpool area.

18. On 5 February 2025, the HCPC Investigating Committee determined that the Registrant had a case to answer in respect of these allegations.  Following correspondence between Blake Morgan LLP on behalf of the HCPC and the Registrant, on 25 February the HCPC Conduct and Competence Committee met (the previous panel) to consider a consensual disposal of the matter, namely that the Registrant would be subject to a three-month Suspension Order.

19.The previous panel determined that it was appropriate to deal with the matter as proposed, and that the three-month Suspension Order provided sufficient public protection for the following summary reasons:

a.    The Registrant understood and agreed to the Order
b.    The Order secured an appropriate degree of public protection
c.    The Registrant had demonstrated insight and referred himself to the HCPC.  Insight had been further demonstrated by the Registrant’s decision to stand down from the role of newly qualified Paramedic to the role of Emergency Medical Technician, a role that did not require registration.
d.    the Registrant’s overall recognition that he was not, at that time, fit to practice as a Paramedic, demonstrated personal reflection and insight into his own capability, level of confidence, and ability to meet the HCPC standards.
e.    The Registrant had made early admissions to his dishonesty when challenged by his crew mate, and admission of misconduct.  His admissions were unequivocal.
f.    The Registrant had acknowledged that his fitness to practice was currently impaired and agreed to the proposed sanction
g.    The Registrant had provided testimonials which provided evidence of insight, including one from his line manager which referred to the Registrant’s personal growth.
h.    Whilst there was limited evidence that the Registrant had reflected on the impact of his dishonest behaviour on the reputation of the profession, his level of insight was sufficient.  The dishonesty was a single incident which was out of character and was not demonstrative of a wider attitudinal issue.
i.    The Registrant had an unblemished record of over four years as an EMT, and this provided reassurance that the risk of repetition was low.

20. The previous panel also determined that the three-month Suspension Order was in the wider public interest.  Despite the HCPC Sanctions Policy indicating that, for dishonesty, a more serious sanction is appropriate, the previous panel was of the view that the dishonesty was an isolated incident, which was not at the high end of the spectrum of seriousness.  The previous panel also considered allegation 1, which concerned patient harm due to insufficient pain relief, but noted that allegation was over a relatively short period of time.  The previous panel considered that the three-month suspension order was appropriate to mark the seriousness of the Registrant’s misconduct and would be compatible with the principles of the HCPC Sanctions Policy.  

21.Accordingly, the previous panel decided to impose a three-month Suspension Order.  

22.The previous panel did not provide any recommendations to the Registrant as to action he could / should take prior to any review of the order to demonstrate that his fitness to practice was no longer impaired, however the letter which was sent to him on 8 April 2026 stated “The panel have not made any recommendations; however you are welcome to provide work or professional development references, reflections, CPD certificates and any evidence of remediation”.  This was also repeated in an email to the Registrant on 19 May 2026.

Preliminary Issue – whether the previous order had expired

23.The Panel noted that there was some confusion within the HCPC documentation about when the suspension order expired and heard advice from the legal assessor on the issue.

24.The previous panel’s decision set out that the suspension order would not come into effect until 28 days after the date on which the notice was served on the Registrant, to allow for the period in which an appeal could be submitted to expire.  

25.However, the Panel was also provided with a copy of the Consent Order made on 25 February, which confirmed “That the Registrar is directed to annotate the register entry of James Green to show that, with effect from 25 February 2026, his registration as a Paramedic is suspended for 3 months”.  If that was correct, the suspension order would already have expired.

26. Unfortunately, to add to the confusion, the letter which was sent to the Registrant on 8 April 2026 informing him of the outcome of the 25 February hearing incorrectly advised him that the previous panel had imposed a four-month Suspension Order, which would expire on 25 June 2026.

27. The Panel received legal advice, and was referred to Article 29(11) of the Health Professions Order 2001 which states that “No order mentioned in paragraph (9) shall have effect….before the expiry of the period within which an appeal against the order may be made”, which, by virtue of article 29(10) is 28 days from the date on which the Registrant is served with the order or decision.

28. The Panel was also referred to the case of Professional Standards Authority for Health and Social Care v Health and Care Professions Council, Mr Ihab Sharf [2025] EWHC 164 (Admin) in which confusion had also arisen regarding the expiry date of an order.  That case confirms that the wording of Article 30(1) and (2) means that a panel has no power to review a substantive order which has already expired.   However, the case also provides that the law is paramount, even where the regulator in its documents has introduced confusion, and that while a panel may decide on the duration of an order, the law determines its start date.

29.In accordance with Article 29(11), the Panel determined that the previous panel’s written decision was correct, and that the three-month suspension order could not have commenced on 25 February 2026 but must have come into force 28 days after the Registrant had been served with the decision.  The Panel assumed that was on the date it was made, i.e. 25 February 2026, as the letter of 8 April 2026 confirms that the Registrant had already been sent a copy by the HCPTS, meaning that the suspension must have come into effect on 25 March 2026, and would expire on 25 June 2026.    

30.The Panel therefore determined that, despite the unfortunate confusion which had been caused, the previous panel’s decision was correct and in accordance with Article 29, meaning the suspension order had not expired, and that they did have the power to review it today.  

Submissions

31.Ms Khorassani on behalf of the HCPC submitted that this is a mandatory review under Article 30 of the Health Professions Order 2001, and that the Panel’s task was to review the suspension order in place in respect of the Registrant, which is due to expire on 25 June 2026.  

32.Ms Khorassani confirmed that the HCPC would be remaining neutral in respect of whether the Registrant’s fitness to practice was currently impaired and as to any order the Panel should make.  

33.Ms Khorassani summarised the background set out above.  She drew attention to the recent emails with the Registrant in which he states he has no intention of using his registration for a number of years, and that he is open to whatever is recommended to proceed, and his awareness that if he wanted to return to practice he would have to complete a course.  Ms Khorassani confirmed that the Registrant would have to complete return to practice courses before he can return to safe and effective practice.

34.Ms Khorassani further confirmed that, prior to the hearing on 25 February 2026, the HCPC had initially proposed disposing of the matter by way of the Registrant and the HCPC entering into a voluntary removal agreement, i.e. that he would no longer be registered as a paramedic.  However, the Registrant had not been prepared to agree to this. 

35.Ms Khorassani confirmed that the question for the Panel today is whether the Registrant’s fitness to practice remained impaired, or whether he has done enough to demonstrate it is no longer impaired.  Ms Khorassani drew the Panel’s attention to the case of Abrahaem v General Medical Council [2008] EWHC 183 (Admin)  which sets out that “there is a persuasive burden on the practitioner at a review to demonstrate that he or she has fully acknowledged why past professional performance was deficient, that through insight, application, education, supervision or other achievement sufficiently addressed past impairment”.

36.Ms Khorassani noted that the previous panel, unusually for a suspension hearing, did not make any suggestions to the Registrant of things he should provide to the Panel, for example, CPD which would aid the Panel’s decision making.  However, she noted the emails to the Registrant of 8 April 2026 and 19 May 2026 which she submitted informed the Registrant that the Panel may be assisted by receiving evidence.

37.Ms Khorassani accepted that, in the absence of any such material from the Registrant and his non-attendance today, the Panel may find it more challenging to establish whether his fitness to practice remains impaired.  She submitted that he had not engaged in a manner that may assist the Panel in its decision making.

38.Ms Khorassani submitted that the Panel should not go behind the findings of the previous panel as they have already been made.  She confirmed that the suspension order must be reviewed before it expires, and that the options open to the Panel, if it found that the Registrant’s fitness to practice remained impaired were to extend the period of the order, make another order which could have been made, or replace the order with one of a different type.  She drew the Panel’s attention to the HCPTS Practice Note on Review of Article 30 Sanction Orders.

39.Ms Khorassani pointed out the steps which the Registrant had taken to address his failings as identified in the previous panel’s decision.  She submitted that a degree of insight had been shown, but that the Registrant had not provided anything to show any steps he had taken to maintain or improve his professional knowledge or skills.  She accepted there had been no further fitness to practice concerns, and also said the Panel should consider whether the Registrant has complied with the existing order.  

40.Ms Khorassani submitted that the current order could be extended which would give the Registrant further opportunity to engage and show he has fully remediated and addressed the failings identified by the previous panel.  However, if the Panel felt that fitness to practice is no longer impaired, it can allow the suspension order to expire on 25 June.

41.Ms Khorassani submitted that if fitness to practice was still impaired, the Panel would need to decide on the appropriate sanction.  She made submissions on the need to have regard to both the personal and public components of impairment, and the need to maintain confidence in the profession and regulatory process, and to uphold standards.

42.Ms Khorassani drew the Panel’s attention to the case of Council for Health and Regulatory Excellence v NMC and Grant [2011] EWHC 927, and the principles set out therein to assist the Panel in determining whether fitness to practice is currently impaired.  She submitted that the HCPC also has an overarching duty to protect, promote and maintain the health, safety and well-being of the public, promote and maintain public confidence in the professions it regulates, and promote and maintain proper professional standards and conduct for members of those professions.

43.Finally, Ms Khorassani submitted that should the Panel go on to consider sanction, the options which should be considered in ascending severity were to take no action, caution, replace the order, or extend the current order.  

44.The Registrant was neither present, nor represented, and had confirmed he was not providing any written submissions or evidence.  The Panel was however provided with a string of recent emails between the Registrant and the HCPC in which the Registrant confirmed that the reason he was not doing so was because he no longer worked in the medical field, and all his evidence which he had initially provided was over 5 years ago.  He confirmed that he had no intention of returning to practice in the near future or “for a number of years at least”.

Decision

45.The Panel received legal advice, which confirmed that, as per Ms Khorassani’s submissions, this is a Review under Article 30(1) of the Health Professions Order 2001, and that it should have regard to the HCPTS Practice Notes on Review of Article 30 Sanction Orders and Fitness to Practise Impairment, as well as the Sanctions Policy.

46. The Panel was aware that it had the power to:

a.    extend the period of the suspension order, 
b.    replace it with an alternative order which the previous panel had the power to make, or 
c.    impose a conditions of practice order (which would come into effect on the expiration of the suspension order if the Registrant resumes work as a paramedic).

47.The Panel was reminded that the review process is not a mechanism for appealing against or ‘going behind’ the original finding that the registrant’s fitness to practice is impaired, which was in accordance with the submissions of Ms Khorassani. The purpose of the review is to consider: -

•    Whether the registrant’s fitness to practise remains impaired; and
•    If so, whether the existing order or another order needs to be in place to protect the public.

48.The key issue which needs to be addressed is what, if anything, has changed since the current order was imposed, and whether fitness to practice was currently impaired. The factors to be taken into account include:

•    the steps which the registrant has taken to address any specific failings or other issues identified in the previous decision;
•    the degree of insight shown and whether this has changed;
•    the steps which the registrant has taken to maintain or improve his professional knowledge and skills; and
•    whether any other fitness to practice issues have arisen.

49.    The Panel understood that fitness to practice means whether a Registrant has the skills, knowledge, character and health to practice safely and effectively.  Impairment means a concern about conduct, competence, health or character which is serious enough to suggest that the Registrant is unfit to practice without restriction (or at all). In determining fitness to practise allegations, panels must take account of two broad components: the ‘personal’ component: the current competence and behaviour of the registrant concerned; and the ‘public’ component: those critically important public policy issues.

50.The Legal Assessor confirmed that the Panel should take into account the cases referred to by Ms Khorassani of Abrahaem v General Medical Council [2008] EWHC 183 (Admin), and CHRE v NMC and Grant [2011] EWHC 927, and were reminded that, in the case of Grant, the High Court considered that an appropriate approach for panels considering impairment might be that which was formulated by Dame Janet Smith in the report to the Fifth Shipman Inquiry, i.e. 

“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: 

a. 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 
b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or 
c. 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 
d. has in the past acted dishonestly and/or is liable to act dishonestly in the future.” 

And, at paragraph 74, 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 professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances.”

51.The Panel was reminded that it should only go on to consider sanction if it found that the Registrant’s fitness to practice was currently impaired.  The Panel decided to retire at this point to determine whether fitness to practice was currently impaired rather than hear legal advice on sanction.  

52.The Panel carefully considered whether the evidence demonstrated that the Registrant’s fitness to practice was currently impaired.  The Panel noted the findings of the previous panel in relation to this, and that, whilst the panel had found impairment at that time, the panel had also set out that the Registrant had shown sufficient insight into his failings, had self-referred, made early admissions, accepted his misconduct, and had worked safely for a significant period of time without repetition.  The previous panel had also found that the dishonesty was an isolated incident which was not demonstrative of a wider attitudinal issue.  

53.The Panel was mindful that its task was to consider what had changed since the suspension order had been imposed and accepted that it had not been provided with any further evidence from the Registrant to demonstrate change.  In an ideal world the Panel considered that it may have been assisted by a reflective piece from the Registrant into his failings.

54.However, the Panel also noted that: 

•    the failings in question took place 5 years ago, and there had been no suggestion of any improper conduct since that time,
•    the previous panel had not made any suggestions or given the Registrant any indication of what more he needed to do in order to remediate or show insight,
•    the letters sent to the Registrant on 8 April 2026 and 19 May 2026 did not indicate that any further evidence was required or would be of assistance, rather they stated he would be “welcome” to provide some 
•    it was the HCPC which had proposed the previous three-month suspension
•    the previous panel had made a series of findings within its decision, that the registrant had shown sufficient insight into his behaviour (paragraphs 26, 28, 29 30 and 36) and that the risk of repetition was low, 
•    the previous panel’s findings were in accordance with the HCPC’s own submissions at that hearing in relation to insight and risk of repetition
•    whilst it did not have access to the evidence which had been provided to the previous panel such as the testimonials etc, that panel had found them persuasive

55.The Panel noted that the HCPC was not advancing a positive case to say that fitness to practice remained impaired and had made no submissions as to what further evidence the Registrant could or should have provided today.  The HCPC made no submission that there had been any further improper conduct, or that the Registrant had not fully complied with the terms of the suspension order.  The previous panel had found (at paragraph 32) that the Registrant had since shown safe and effective practice in the role of Emergency Medical Technician.

56.Therefore, whilst the Panel had not been provided by the Registrant of any evidence as to what had changed since his fitness to practice had been found to have been impaired, it was difficult to see what more the Registrant could have been expected to provide other than the evidence seen by the previous panel.  That panel had clearly reached findings, on the encouragement of the HCPC, that the Registrant had shown sufficient insight into his behaviour, The Panel was mindful that it could not go behind those findings.

57.The Panel accepted the submission of Ms Khorassani that, before returning to practice, the Registrant will have to complete return to practice courses, and that the Registrant is aware of this, as demonstrated by his recent email to the HCPC.  The Panel noted that this will require him to demonstrate good clinical practice and that he is able to meet the standards.  This will include clinical placements and supervision.  The Panel further noted that the findings would remain on the Registrant’s record for 3 years, which would also provide an additional safeguard were the Registrant to return to practice and any further concerns arise.   

58.The Panel considered that the evidence did not demonstrate that the Registrant’s fitness to practice was currently impaired in relation to the personal component. 

59.The Panel went on to consider the public component of impairment, i.e. the need to declare and uphold proper standard of behaviour and maintain public confidence in the profession.  The Panel noted that the HCPC, whilst advancing no positive case today, had at the previous hearing submitted that “the public interest requires the imposition of a short suspension order, to reflect the serious nature of dishonesty and in order to uphold proper standards of conduct and to maintain public confidence in the profession and the HCPC as its regulator.”  It was on that basis that the HCPC had suggested the three-month suspension order.

60.The previous panel had agreed with that submission, and that the three-month suspension would mark the seriousness of the conduct, and would be compatible with the principles of the HCPC Sanctions Policy, sending a clear message to members of the profession and the public that dishonesty and a failure to administer adequate pain relief to a patient is not acceptable within the Paramedic profession.

61.The Panel agreed that the particulars, which had been admitted by the Registrant, were serious.  However, it was not of the view that fitness to practice remained impaired on this basis.  The previous panel had already determined what would be required in order to send a clear message and ensure confidence in the profession and the regulator.  The HCPC had previously asked for the Order which they felt was appropriate in order to secure that confidence, and that order had been made.  The Panel noted that they could not go behind the previous panel’s findings, but in any event, agreed that the short suspension which had been imposed was sufficient to secure public confidence that the Regulator was doing its job effectively.  The Panel did not consider that a finding of continued impairment was justified on that basis, or that a further order / extension of the present order would do any more to further secure public confidence.  

62.For all the above reasons, the Panel found that the Registrant’s fitness to practice had not been shown to be currently impaired and did not go on to consider sanction.

ORDER: The Registrar is directed to allow the current Suspension Order against the registration of James Green to lapse upon its expiry, namely 25 June 2026.

No notes available

History of Hearings for James Green