Mr Andrew Robinson

: Paramedic

: PA15240

: Final Hearing

Date and Time of hearing:10:00 22/03/2017 End: 17:00 24/03/2017

: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

: Conduct and Competence Committee
: Caution

Allegation

(as amended)

Whilst employed as a Paramedic with East Midlands Ambulance Service NHS Trust:

1.     You worked as a Paramedic whilst you were not registered in the Paramedic part of the Health Professions Council and/or Health and Care Professions Council Register on various dates between-

 

a.     3 September 2005 and 13 September 2005; and/or

 

b.     11 February 2009 and 4 May 2010; and/or

 

c.     8 August 2012 and 13 September 2012; and/or

 

d.     7 February 2014 and 4 June 2014.

 

2.     The matters set out in paragraph 1 constitute misconduct.

 

3.     By reason of your misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Application to amend the Allegation

1.             Ms Williams, for the HCPC, applied to amend the Allegation in a number of respects. The Registrant had been given notice by the HCPC of most but not all of the proposed amendments by letter dated 15 June 2015. Mr Elton, on behalf of the Registrant, indicated that there were no objections to any of the proposed amendments.

 

2.             In reaching its decision, the Panel has reviewed each proposed amendment and the reason advanced for it, in turn. The Panel has considered whether the proposed amendments can be made without causing injustice or prejudice to the Registrant. The Panel noted that the Registrant has not objected to any proposed amendment. It decided to grant the HCPC’s application in full, being satisfied that the Registrant would not be prejudiced and there would be no injustice caused.

Application for part of the hearing to be conducted in private

3.             Mr Elton, on behalf of the Registrant, applied for those parts of the proceedings concerning health issues to be heard in private to protect the private life of the Registrant and of his family. Ms Williams, on behalf of the HCPC, did not oppose the application.

 

4.             In reaching its decision, the Panel has considered the matters set out in the HCPC’s Practice Note on “Conducting Hearings in Private”. It has received and accepted legal advice. The Panel has decided to grant the application. It is satisfied that it is appropriate in this case for matters relating to the Registrant’s health and private life to be heard in private.

Background

5.             The Registrant, Andrew Robinson, is a qualified Paramedic. From 4 December 1995, he was employed by the Lincolnshire Ambulance Service and thereafter by the East Midlands Ambulance Service NHS Trust (the Trust). He qualified as a Paramedic in December 2004 and was first registered with the Health Professions Council (HPC) (as it then was) on 21 February 2005. During his employment with the Trust, the Registrant’s role changed and he worked in different teams and at different ambulance stations.

 

6.             In July 2014, the HCPC notified the Trust that the Registrant’s registration had lapsed and he was no longer registered to practice as a Paramedic. The Registrant was off work on sick leave between 5 June 2014 and 29 September 2014. The Trust informed the Registrant that because his registration had lapsed, he would be downgraded to the role of Emergency Care Assistant (ECA). The Trust carried out an internal investigation into the alleged lapse in registration. This resulted in a Disciplinary Hearing on 17 December 2014.

 

7.             The Trust referred the matter to the HCPC on 19 August 2014. The Registrant also referred himself to the HCPC in an email dated 6 November 2014.

 

8.             During the HCPC investigation three earlier periods emerged where it is alleged that the Registrant worked as a paramedic when he was not registered.

 

9.             The Registrant is still employed by the Trust and, after re-registering with the HCPC, has been working as a registered Paramedic at the Trust’s Boston Ambulance Station.

Submission of no case to answer (Particular 1a)

10.           At the conclusion of the HCPC’s case, the Panel invited submissions in relation to the sufficiency of evidence on Particular 1a of the Allegation. Mr Elton, for the Registrant, submitted that either there was no evidence that the Registrant had worked as a paramedic during the relevant period, or that such evidence as there was, was unsatisfactory in nature. Ms Williams, for the HCPC, indicated that the HCPC adopted a neutral position as to whether there was sufficient evidence.

 

11.           The Panel has applied the test set out in the HCPC’s Practice Note on “‘Half Time’ Submissions”. It has received legal advice. The Panel noted that the stem of the Allegation refers to the Registrant being “employed” as a Paramedic whilst the stem of Particular 1 refers to the Registrant having “worked” as a Paramedic. It concluded that this indicated that there was a distinction in the use of those two words and decided that where the word “worked” was used, this denoted a period of shift work as a Paramedic.

 

12.           The Panel has decided that whilst there is evidence on which it could conclude that the Registrant was not registered on the HPC Register (as it then was) during the period 3 September 2005 to 13 September 2005, there is no direct evidence on which it could conclude that he had worked any shifts as a Paramedic on any of those ten days. There was evidence the Registrant was based at Spalding Ambulance Station in the paramedic role of Acting Clinical Team Leader at that time. The Trust was unable to provide any records of what shifts the Registrant had worked during that period. Nor was there any evidence regarding periods when the Registrant was not working as a Paramedic, for example, due to rest days, training days, holidays, or sick leave, and so the Panel was of the view that it could not exclude the possibility that during the period, the Registrant might have been absent from work. The Panel concluded that in the absence of any direct evidence to show the Registrant was working as a Paramedic on any day during the relevant period, there was no proper factual basis on which it could draw an inference that it was more likely than not that the Registrant had worked as a Paramedic during those ten days. In these circumstances, the Panel has found that there is no case to answer in relation to Particular 1a.

Decision on Facts

13.           The Panel heard evidence from three witnesses and also received in evidence a number of documents which concerned the Registrant’s employment with the Trust, its internal investigation, and the HCPC’s Registration process. The Panel heard evidence from the Registrant. It has also received a number of testimonials.

 

14.           KT is a Human Resources Advisor at the Trust. He gave evidence of the various roles in which the Registrant had worked during his employment with the Trust and produced records held by the Trust regarding the Registrant’s shifts for the later periods set out in Particular 1, as well as periods of sick leave. It was clear from KT’s evidence that the Trust moved to an electronic record system in 2012 and that the paper records of shifts worked prior to this date were not always retained, and so the documentary evidence of that period is incomplete.

 

15.           EH is a registered Paramedic employed by the Trust. In October 2014, she was appointed by the Trust to investigate an allegation that the Registrant had been working as a Paramedic whilst he was not registered to practise with the HCPC. She gave evidence of her investigation, which was limited to events in 2014 and set out in Particular 1d of the Allegation.

 

16.           DA is employed as a Registration Manager by the HCPC Registrations Team and gave evidence regarding the registration process and the entries in the Paramedic part of the relevant Register for the Registrant.

Particular 1b – Proved

17.           Particular 1b was found proved by the Panel. This was the longest period during which it was alleged that the Registrant worked as a Paramedic when he was not registered with the HPC (as it then was). The Panel was satisfied on documentary evidence produced by the HCPC that the Registrant was not registered as a Paramedic during the period 11 February 2009 to 4 May 2010. The Panel was also satisfied that it was more likely than not that during that period of some 14 months, the Registrant had worked as a Paramedic whilst not registered. The Panel also noted that the Registrant accepted in his evidence that he had done so. Even though there was no documentary evidence from the Trust of the shifts worked by the Registrant during that time, there was evidence that he had been unable to work on certain dates due to ill health. The Panel concluded that the length of the period was such that even if there would have been times when the Registrant was not working as a Paramedic due to rest days, holidays and training days, it was reasonable and proper for it to draw the inference that there had also been days when he had worked as a Paramedic whilst unregistered.

Particular 1c – Proved

18.           Particular 1c was found proved by the Panel. This related to a relatively short period of time between 8 August 2012 and 13 September 2012. In reaching its decision, the Panel relied on documentary evidence produced by the HCPC which showed that the Registrant was not registered as a Paramedic during that period. The Panel was also satisfied that it was more likely than not that the Registrant had worked as a Paramedic on some 14 shifts. It relied on documentary evidence produced by the Trust which showed the shifts worked by the Registrant during the period. The Panel noted that the Registrant had accepted in his evidence that the document setting out his shift pattern at that time accurately reflected the position.

Particular 1d – Proved

19.           Particular 1d was found proved by the Panel. This related to the period 7 February 2014 to 4 June 2014, a period of some four months. The Panel was provided with documentary evidence produced by the HCPC which showed that the Registrant was not registered as a Paramedic during that period. The Panel also relied on documentary evidence provided by the Trust which showed the Registrant’s shifts during that period and was satisfied that it was more likely than not that he had worked as a Paramedic on 52 shifts during that period when he was not registered. The Panel noted that the Registrant had accepted in his evidence that the document setting out his shift pattern at that time accurately reflected the position.

Decision on Grounds

20.           In reaching its decision on the statutory ground of misconduct, the Panel has taken the submissions of both parties into account and has accepted legal advice. It has considered the HCPC’s “Standards of Conduct, Performance and Ethics” in force during the period covered in Particular 1 b-d and finds the following standard to have been engaged and breached:

Standard 13                 You must….make sure that your behaviour does not damage the public’s confidence in you or your profession.

21.           The Panel concluded that in acting in the way he did, the Registrant’s behaviour damaged the public’s confidence in the Paramedic profession. The Panel noted that in his evidence, the Registrant accepted that he had breached this Standard and said that it was one of the things that he was really sorry about.

 

22.           The Panel also concluded that the Registrant has breached the following HCPC “Standards of Proficiency for Paramedics” in force during the period, which state that Paramedics must:

Standard 1a

Professional autonomy and accountability

Registrant paramedics must:

Standard 1a.1: be able to practise within the legal and ethical boundaries of their profession

-       understand what is required of them by the Health Professions Council

23.           The Panel decided that this sub-paragraph of Standard 1a.1 included the requirement to be registered as a Paramedic and that the Registrant had breached it by his failures to keep his registration up to date.

 

24.           In deciding whether the facts found proved amounted to misconduct, the Panel bore in mind that not every breach of a standard will necessarily amount to the statutory ground of misconduct. It has concluded that the matters found proved in Particular 1 b-d of the Allegation amount to serious misconduct. It considers that this is the sort of behaviour that other professionals would find deplorable.

 

25.           It reached this conclusion for the following reasons:

 

     These were not isolated incidents;

 

     The first period in Particular 1b was over 12 months, which is a considerable period of time to be practising without registration;

 

     Whilst the two subsequent periods in Particulars 1c and 1d were for relatively short periods of time, the Registrant had again allowed his registration to lapse;

 

     The Registrant, as an autonomous practitioner, was personally responsible for ensuring that his registration was kept up to date;

 

     The result of these three lapses in registration could have had a significant adverse impact on his employer involving litigation.

Decision on Impairment

26.           In reaching its decision in relation to impairment, the Panel has borne in mind that the purpose of these proceedings is not to punish the Registrant for past misdoings but to protect the public against the acts and omissions of those who are not fit to practise. It has also borne in mind the HCPC’s Practice Note on “Finding that Fitness to Practise is Impaired”.

 

27.           The Panel first considered the personal component. The Panel was satisfied that the Registrant had taken concrete and practical steps to set aside an amount each month so that he would have sufficient funds to pay the HCPC when required to do so. He had also taken wider steps with his bank to manage his finances more effectively.

 

28.           The Registrant has put in place a support network to assist him in managing any personal difficulties which he may encounter in the future. He has also succeeded in developing an open and effective dialogue with his managers so that they are more aware of his personal situation and able to offer assistance where required.

 

29.           The Panel was also satisfied that the Registrant had demonstrated very good insight into the damage that his conduct had caused to the reputation of the Paramedic profession. In the circumstances, the Panel was satisfied that it was highly unlikely that the misconduct would be repeated.

 

30.           The Panel noted that there were no clinical concerns regarding the Registrant’s practice and that the character references and testimonials all indicate that he is a highly proficient and well regarded Paramedic. The Panel therefore concluded that on the personal component the Registrant’s fitness to practise was not impaired.

 

31.           The Panel then considered the public component. The Panel bore in mind that the test for impairment required it to assess fitness to practice as of today, looking forward. In making that assessment, the Panel considered whether public interest factors required a finding of impairment even though there was no on-going risk to the public. In particular, the Panel was satisfied that the Registrant had acted in the past to bring the profession into disrepute and had breached a fundamental tenet of the profession, although it did not consider that he was likely to do so in the future.

 

32.           The Panel concluded that there were three relevant factors. First, there was a need to restore public confidence in the Paramedic profession. The public was entitled to expect Paramedics to comply with the basic requirement to be on the Register. For a professional of the Registrant’s experience to have been repeatedly in breach of this requirement has a damaging effect on public confidence.

 

33.           Second, the Panel considered the need to uphold proper standards of conduct and behaviour. It concluded that members of the Paramedic profession would recognise the importance of registration and would be concerned where a registrant had continued to practise for a lengthy period of time whilst unregistered and where this had been repeated conduct.

 

34.           Third, the Panel considered public confidence in the regulatory process. The HCPC is entrusted with responsibility to regulate the Paramedic profession. The Panel was satisfied that where the HCPC identifies a practitioner who should be registered and who, on repeated occasions, fails to keep his registration up to date, the public would expect the regulator to take appropriate action. In this case, the HCPC did do so. It notified the Trust in relation to lapses in registration in 2012 and again in 2014 and when, on further investigation, it discovered the persistent nature of the Registrant’s failure to maintain his registration, the HCPC commenced these regulatory proceedings.

 

35.           The Panel is satisfied that a finding of impairment is required in this case to satisfy these three critically important public policy issues. Accordingly, the Allegation is well founded.

Decision on Sanction

36.           In considering the appropriate and proportionate sanction in this case, the Panel was referred to and took account of the HCPC’s Indicative Sanctions Policy. The Panel has also considered the submissions of both parties, and all the evidence adduced in the case, including the various references and testimonials.

 

37.           The Panel reminded itself that the purpose of a sanction was not to be punitive, although a sanction may have a punitive effect. It bore in mind the need for proportionality, which included balancing the interests of the Registrant with those of the public. The Panel recognised that this was not a case where the Registrant posed a risk to public safety, but that it was still necessary to give appropriate weight to the wider public interest.

 

38.           The Panel has taken account of the following aggravating factors:

 

     Given the repeated nature of his misconduct, the Registrant should have had a heightened awareness of his situation as he had been notified on the first two occasions by the Trust of lapses in his registration;

 

     The length of time the Registrant had practised as a Paramedic whilst unregistered.

 

39.           The Panel has taken account of the following mitigating factors:

 

     The Registrant admitted his wrongdoing from the outset and recognised the impact of his actions on the reputation of the Paramedic profession and on his employer;

 

     He has engaged in a very positive way with the regulatory process;

 

     He has shown candour in volunteering information which was not otherwise before the Panel, and has been open and frank;

 

     This is not a case in which there are any concerns as to his clinical skills and no harm was caused to service users by his actions;

 

     Whilst the personal circumstances of a registrant are of limited importance in regulatory proceedings, there were features regarding the Registrant’s health and family life which had a profound effect on him at the relevant time, but which are no longer having a negative impact on his professional life.

 

40.           The Panel considered the available sanctions in ascending order of seriousness. It decided that there were no exceptional circumstances which would make it appropriate in this case to take no further action. This was because: (i) the misconduct had occurred on three separate occasions; (ii) the serious nature of the facts were such that taking no action would not sufficiently address the public interest concerns, restore public confidence in the Paramedic profession or maintain confidence in the regulatory process; and (iii) taking no action would send out the wrong message to the profession about the importance of maintaining registration and so would be insufficient in its deterrent effect.

 

41.           The Panel next considered imposing a Caution Order. It had particular regard to paragraph 22 of the Indicative Sanctions Policy, which states:

“…A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practise would be disproportionate.”

42.           The Panel has already concluded that the risk of repetition is low and recognises that the Registrant’s conduct in this case was influenced by personal circumstances which are no longer pertinent. The Panel is of the view that there are no meaningful Conditions of Practice which would be appropriate because there are no concerns regarding the Registrant’s clinical skills or any behavioural matters which should be addressed. The Panel considered that a Suspension Order would be wholly disproportionate in these circumstances, bearing in mind that although the misconduct was serious, it does not require suspension from practise in order to satisfy the public interest concerns in this case. Such an order would deprive the community of the services of a safe and competent Paramedic. The Panel noted the personal impact on the Registrant of suspension, which would result in a significant reduction in salary if he was unable to practise as a Paramedic, and decided that such a course would be unduly harsh and punitive in nature.

 

43.           The Panel decided that a Caution Order was the appropriate and proportionate sanction. The Panel then went on to consider the period of time for which it should be imposed. It had regard to paragraph 23 of the Indicative Sanctions Policy and decided that an order for the minimum period of 12 months was not sufficient in light of the aggravating features which it has noted, and would not address adequately the public interest concerns which it has identified.

 

44.           The Panel was of the view that the bench mark period of 3 years was a disproportionate length of time to be subject to a Caution Order bearing in mind the mitigating factors it had identified.

 

45.           The Panel therefore concluded that a Caution Order for a period of 2 years would be proportionate and sufficient to address the public interest concerns set out in this case and provided the appropriate balance between the interests of the public and those of the Registrant.

Order

That the Registrar is directed to annotate the register entry of Mr Andrew Robinson with a caution which is to remain on the register for a period of 2 years from the date this order comes into effect.

Notes

This Conduct and Competence Committee Panel Final Hearing is to take place at HCPC, London on Wednesday 22 March 2017 to Friday 24 March 2017 at 10:00am

Hearing history

History of Hearings for Mr Andrew Robinson

Date Panel Hearing type Outcomes / Status
22/03/2017 Conduct and Competence Committee Final Hearing Caution
02/06/2016 Conduct and Competence Committee Final Hearing Adjourned