Jeremy Bailey

Preliminary Matters

Service

1. The Panel was satisfied that the email sent to the Registrant on 15 May 2024, informed him of the date and time of the hearing, as well as the fact that the hearing would be conducted by the use of Microsoft Teams. Accordingly, the email satisfied the requirements of a Notice of Hearing.

Proceeding in the absence of the Registrant

2. After the Panel stated that it was satisfied that there had been good service of the Notice of Hearing, the Presenting Officer applied for a direction that the hearing should proceed in the absence of the Registrant.

3. The Panel accepted the advice it received from the Legal Assessor concerning the decision on whether to order that the hearing should proceed in the absence of the Registrant. It considered the factors identified in the relevant HCPTS Practice Note. The Panel accepted that the decision that there had been good service of the Notice was a necessary, but not sufficient, factor to be applied to the decision. The Panel should only make the direction sought if satisfied that in all the circumstances it would be fair to do so.

4. Having carefully considered the matter, the Panel concluded that the hearing should proceed notwithstanding the absence of the Registrant. The reasons for this decision were the following:

• The Registrant ceased to engage in the fitness to practice process in about April 2024, and had since made it clear that he did not intend to participate in this hearing;
• He had not sought an adjournment of this hearing, nor in any other way had he suggested that he would participate in the future;
• Accordingly, there were no grounds on which the Panel could conclude that the Registrant would participate to a greater extent were the hearing to be adjourned;
• In these circumstances, the Registrant had voluntarily absented himself from the hearing;
• The HCPC had arranged for the two individuals whom it intended to call as witnesses to be available for the hearing, and they would be caused inconvenience were the hearing to be adjourned;
• There is a clear public interest in the expeditious disposal of fitness to practise proceedings;
• The above factors resulted in the public interest in the hearing proceeding outweighing any disadvantage arising from the Registrant’s absence.

Part of the hearing to be held in private

5. Before opening the case, the Presenting Officer requested the Panel to direct that any part of the hearing when there would be mention of a health condition affecting the Registrant should be conducted in private. He acknowledged that the expectation is that fitness to practise hearings will be conducted in public, but submitted that the need to protect the Registrant’s private life would require the direction sought.

6. The Panel accepted the advice it received from the Legal Assessor concerning the decision to be made. Having discussed the matter, the Panel agreed to the direction sought on the ground advanced by the Presenting Officer.

Application to amend a factual particular of the allegation

7. During the hearing, the Presenting Officer applied to amend the wording of particular 3(a). That element of the allegation as referred by the Investigating Committee alleged that during his employment by South Central Ambulance Service NHS Foundation Trust (“SCAS”), the Registrant took unprescribed Dihydrocodeine in or around October 2020. The evidence the HCPC proposed to rely on in support of this contention included what is said to have been an admission by the Registrant in communications to HCPC, and the evidence of EF that she discovered in the Registrant’s bedroom, Dihydrocodeine without either box or evidence of a prescription for it. EF’s witness statement had not indicated when this discovery had been made, but in oral evidence she said that it had been in about the summer of 2021. However, the allegation related not to mere possession, but taking the drug. EF’s discovery could not answer the question of when any Dihydrocodeine might have been taken. Accordingly, the HCPC sought to delete from the particular that it had been taken in or around October 2020. The Presenting Officer submitted that it would be appropriate to permit this amendment, and that the Registrant would suffer no prejudice were the Panel to allow it.

8. The Panel accepted the advice of the Legal Assessor. In the view of the Panel, the gravamen of the particular was not affected by the removal of the reference to October 2020, as the mischief to which the particular was directed was the allegation that the Registrant had used the drug during his employment with SCAS, and that contention was contained in the stem of particular 3. The Panel also concluded that the Registrant would suffer no prejudice by the removal of the reference to October 2020, as he had not made a positive case for the purposes of this hearing, and in any event he had been given the opportunity of acquainting himself with the evidence upon which the HCPC intended to rely. The conclusion of the Panel was that the application to amend particular 3(a) should be acceded to.

The nature of the allegation and the order in which matters were decided

9. The allegation referred by the Investigating Committee is a “dual allegation”; it alleges that the Registrant’s fitness to practise is impaired by reason of both misconduct and impaired health. The Panel heeded and applied the guidance contained in the HCPC document headed, “Approach to dual allegations” revised in June 2021. The referral having been made to the Conduct and Competence Committee for hearing, it followed that the misconduct allegation is the primary allegation.

10. In the Case Summary prepared by the Presenting Officer and dated 5 August 2024, it was indicated that the Panel would be invited to conduct the hearing by deciding the factual issues before addressing any other issues. The Panel agreed to adopt this course.

Background

11. The Registrant is registered with the HCPC as a Paramedic. He commenced working for SCAS in April 2020. At that time, he was a third year student and was employed as a temporary newly qualified paramedic during the Covid-19 pandemic. Later in 2020, he qualified as a Paramedic and became a newly qualified Paramedic.

12. On 26 February 2021, BK, a Paramedic and the Registrant’s manager, received an email from DW, an Emergency Care Assistant. In the email, DW stated that when he had been working alongside the Registrant on 21 February 2021, he had seen the Registrant put in his personal bag, two empty vials that had contained oral morphine and put the bag under the driver’s seat of the ambulance. On 27 February 2021, BK spoke to the Registrant about the incident, and it is the HCPC’s case that on that occasion, the Registrant denied that he had ever taken empty containers. It is these facts that the HCPC relies upon in support of its case in relation to particular 2. The oral morphine referred to was morphine sulphate oral solution 10mg in 5ml. The containers for it were very small bottles, the estimated size of them being approximately 5cm tall and 3cm wide. This medication is referred to in this determination as “Oramorph”.

13. EF shared a house with the Registrant. On 26 June 2021, BK received an email from a Paramedic Team Leader, AD, who had been working with EF. The email stated that EF had disclosed to AD that, as the Registrant’s housemate, she had seen oral morphine bottles in the Registrant’s bedroom. There was also mention of EF referring to the use of cannabis and cocaine by the Registrant. EF was asked to write a statement. Further reference will be made to this statement below. The evidence that emerged following the disclosure by EF is relevant to the contentions of drug use alleged by particular 3.

14. Following the disclosure by EF, the Registrant was spoken to by BK as his manager, and MC, who was BK’s manager. It is contended that during this interview, the Registrant stated that in his bedroom at home he probably had eight empty Oramorph bottles, which he said he had for the purpose of growing seedlings in. During this interview there was discussion about the use of other drugs, including Dihydrocodeine, cocaine and cannabis. Following the meeting, BK went to the Registrant’s house where thirteen empty and unwashed Oramorph bottles were retrieved in a tin either under or at the side of the Registrant’s bed. The evidence of these retrieved bottles is relevant to particular 1.

Decision on Facts

15. The Panel accepted the advice it received from the Legal Assessor concerning the proper approach to its findings on the factual elements of the case. Accordingly, the Panel kept in mind that in relation to all relevant facts, the burden rested on the HCPC to prove, the standard of that burden being the balance of probabilities. At no stage should the Registrant be expected to disprove any issue. Furthermore, the Panel was required to consider each of the factual elements of the allegation separately, being scrupulous as to the evidence that could logically bear upon it. In this regard the Panel heeded the warning given by the Presenting Officer that there were elements of the evidence contained in the hearing bundle that the HCPC would have considered it appropriate to redact, but, as the Registrant would not agree to the redactions, they were not removed. Further, the Registrant’s absence should not lead to any adverse inference against him being drawn.

16. The HCPC called two witnesses to give evidence before the Panel. They were EF and BK. The roles of both of them have already been described. In addition to the witness statements made by each of the witnesses for these proceedings, the HCPC produced a substantial body of documentary exhibits. Included in the documentary exhibits was the statement made by EF following her disclosure and records of interviews with the Registrant.

17. The Registrant has not provided any submissions for the purposes of this hearing. It was apparent that the Registrant did not accept any of the HCPC’s evidence. In an email dated 11 July 2024, sent to the HCPC’s Solicitors in which he replied to a request from them that he agree certain redactions, the Registrant stated, “I don’t want ANYTHING redacted; [EF] and [BK] will have to explain why they have lied – so much!” The Panel has, however, been provided with other documents that have been created by the Registrant at earlier stages. They are:

• His self-referral document sent to the HCPC on 20 October 2021 (“the self-referral”).
• A document headed, “Maintaining Professional Standards outside of the Workplace: A Reflection Upon Personal Substance Misuse” sent by the Registrant under cover of an email dated 14 December 2021 (“the reflection document”).

Particular 1 – Between approximately June 2020 and February 2022, you did not dispose of unused medicines correctly, in that you had taken several used empty oral morphine bottles to your personal property over a period of at least 12 months.

18. The Panel accepted the evidence of BK, that following the interview of the Registrant on 1 July 2021, during which the Registrant stated that he probably had eight empty used Oramorph bottles in his bedroom, he (BK) went to the Registrant’s home and 13 empty used Oramorph bottles were found in a tin either under or at the side of the Registrant’s bed. That these bottles had been taken by the Registrant over a period of time is demonstrated by the fact that the expiry date printed on one of the bottles is 17 October 2020, more than 8 months before the date they were retrieved. In the view of the Panel it is a legitimate inference for it to draw that the Registrant retained this bottle before that expiry date. The Panel heard evidence from BK about the procedures governing the re-stocking of drug supplies for paramedics attending patients, and on the basis of that evidence the Panel considers it to have been very unlikely that an out of date bottle would have been available to the Registrant when working. It was accepted by SCAS, following an audit of the Oramorph provided to patients by the Registrant, that the only opportunity the Registrant would have had to retain an empty bottle would have been after the contents had been administered to a patient.

19. Having regard to all the circumstances, the Panel finds that the HCPC has discharged the burden of proving particular 1.

Particular 2 – On or around 26 February 2021, you denied previously placing oral morphine bottles into your personal rucksack when this was untrue.

20. In relation to this particular, there are two distinct matters that the HCPC would be required to prove before the Panel could find the particular proven, namely:

• that the Registrant placed oral morphine bottles in his personal rucksack;
• that on or around 26 February 2021, the Registrant denied doing so.

21. It has already been described in the background summary of this determination that it was on 26 February 2021 that DW emailed BK stating that five days earlier the Registrant had placed two empty Oramorph bottles in his rucksack. The Panel has been supplied with a copy of DW’s email to BK, but the HCPC did not call DW as a witness at the hearing. It therefore followed that the evidence relating to the taking of the Oramorph bottles on 21 February 2021, was hearsay in nature. The Panel carefully considered whether it could properly admit, and if admitted, accept that evidence as reliable.

22. The Panel considered whether it should permit the hearsay evidence of DW to be admitted in evidence. This involved a decision on the fairness of doing so. The Panel acknowledged that for the purposes of establishing that, prior to 26 February 2021, the Registrant had placed empty morphine bottles into his personal rucksack, the evidence of DW was the sole evidence. The Panel accepted that the HCPC had made no attempt to secure the attendance of DW and that the allegation in question is serious with a potentially serious impact on the Registrant’s career. However, notwithstanding this, the Panel concluded that the hearsay evidence of DW should be admitted in evidence. The reasons for this decision were:

(i) The evidence of DW is in the written form of an email he wrote himself; it was not dependent on the evidence of BK that it the issue had been raised with him;
(ii) It is apparent from the terms of the email (which included DW stating “I am very sorry that it has taken me a couple of days to speak to you [i.e. BK] I just did not know what to do about this. It has been playing on my mind since the incident and that is why I have spoken to you today about this”) that the issue was not raised by DW lightly;
(iii) The Registrant had an opportunity of addressing the matter on 27 February 2021;
(iv) There is no reason for the Panel to believe that DW had a malicious motivation in disclosing the matter, and the Registrant did not contend when spoken to on 27 February 2021 that there was any such motive.
(v) The Registrant was aware that the evidence was included in the evidence to be put before the Panel as it is referred to in paragraph 13 of BK’s witness statement, and a copy of the email itself is included in the exhibits to BK’s statement.

23. Having decided to admit the evidence, the Panel considered what weight should be attached to the evidence, it came to the conclusion that it could give weight to the hearsay evidence. That decision was based on the fact that the discovery of 13 Oramorph bottles in the Registrant’s bedroom tended to support the hearsay evidence of DW as to what happened on 21 February 2021. Another factor that tended to support that hearsay evidence was the direct evidence of BK who checked the electronic patient record and discovered that two small bottles of Oramorph had been used on the occasion described by DW.

24. As to the alleged denial by the Registrant that he had taken the bottles, the Panel received the direct evidence of BK as to that denial. Furthermore, BK’s evidence was supported by a file note made in relation to the meeting held at 07:30 on 27 February 2021, in which it is said that the Registrant made the denial. The file note is in these terms,

“I [BK] met with [the Registrant] to put this allegation to him. He initially needed reminding of the incident where he had administered oromorph [sic]. He then recalled the incident stating the vehicle had no intravenous morphine and when asked about where he placed the vials he said ‘on the side’. He denied ever intentionally putting them into his bag but stated he would check his bag and let me know if he found them in there. I made it very clear to [the Registrant] that these vials must never be placed in one’s own bag but into the sharps bin as per Trust Policy. We agreed that it was one persons word against another’s so this would not be taken any further. However, it was made clear of the correct procedure for the disposal of medicine vials”.

25. Following the interview on 27 February 2021, the Registrant did not communicate to BK whether he had checked his bag, or, if he did, what he discovered. The Panel therefore finds that on 27 February 2021, the Registrant denied taking the two Oramorph bottles.

26. Having found that the HCPC discharged the burden of proof in relation to the two factual elements of the particular, the Panel finds particular 2 proven.

Particular 3 - During the course of your employment with South Central Ambulance Service you took the following drugs:

a. Unprescribed Dihydrocodeine;
b. Cocaine in or around May 2021;
c. Cannabis in or around June 2021.

27. The Panel considered the HCPC’s case on the three drugs particularised in Particular 3 separately, but there is a factor arising from the stem that must be explained, not least because it has particular relevance to the Panel’s finding in relation to Dihydrocodeine. For the Panel to make a finding against the Registrant, it would be necessary for it to be established that he took (as in self-administered) the drug, not that he merely had it in his possession. Furthermore, any taking of the drug proven would be required to have taken place during the course of the Registrant’s employment with SCAS, that is to say after April 2020.

Dihydrocodeine

28. The evidence relating to Dihydrocodeine was as follows:

• The evidence of EF that she saw Dihydrocodeine in the Registrant’s bedroom in the summer of 2021. Furthermore, the appearance of the Dihydrocodeine seen by EF did not suggest that it had been prescribed to the Registrant;
• When interviewed by BK and MC on 1 July 2021, the Registrant is recorded as having stated in reply to a question by BK as to whether he was prepared to discuss the use of Dihydrocodeine, the following: “Shoulder pains for years, dihydrocodeine not prescribed to me. GP doesn’t give me codeine any more. It’s my brother’s medication.”
• In the reflection document, the Registrant stated, “I disclosed possession and historical consumption of dihydrocodeine for acute-on-chronic right shoulder pain.” In the same document he stated, “This bias also led me to the impression that using a family members dihydrocodeine for breakthrough shoulder pain was acceptable, as I had been prescribed codeine in the past from my general practitioner.”

29. The Panel accepted the evidence summarised in the immediately preceding paragraph, and, on the basis of that evidence, it found that the HCPC had discharged the burden of proving that, during his employment with SCAS, the Registrant was in possession of Dihydrocodeine that had not been prescribed to him.

30. However, as to whether the HCPC had discharged the burden of proving that the Registrant had taken Dihydrocodeine during the time he was employed by SCAS, the Panel found that it had not. EF’s evidence of finding the drug was not, in the view of the Panel, sufficient to prove that it had been taken by him in the preceding 15 months or so. Furthermore, the Registrant’s acceptance of use of it was that it had been “historic”.

31. Accordingly, the Panel finds that particular 3(a) is not proven.

Cocaine

32. EF heard rumours of cocaine use by the Registrant and another colleague during a social event in May 2021, but could not give positive evidence that it had been used. Similarly, BK, who had been at the social event, was aware of the suggestion that the Registrant and a colleague had used cocaine, but he could not give positive evidence that it had been used. Had the matter ended there, the contention in relation to cocaine would not have been proven. However, in both his self-referral and reflection document, the Registrant referred to the use of cocaine. In the former he wrote: “…I admitted to a single use of cocaine on an isolated occasion in July 2021. At the time, I was attending a social event and under the influence of alcohol.” In the latter, he wrote: “I acknowledged and disclosed historical use of illicit substances, including: …An isolated consumption of a small quantity (a ‘key’) of cocaine in mid-May 2021 during a social event…” The acceptance by the Registrant in his own documents is consistent with the evidence of BK that during the interview on 1 July 2021, the Registrant accepted that he had used cocaine, albeit that he was not specific in that interview as to when he had used it.

33. Having regard to all the evidence, the Panel was satisfied that the HCPC had discharged the burden of proof in relation to particular 3(b), which is proven.

Cannabis

34. The Registrant and EF began working for SCAS at about the same time and they began to share a house shortly after they began their employment. EF gave evidence that the Registrant used cannabis in the house they shared. Furthermore, in the documents to which reference has already been made, the Registrant accepted having used cannabis. In the self-referral he stated, “I additionally admitted to smoking a small amount of cannabis (a few ‘draws’ of a joint which was passed around a group of friends during a day on the beach while away at home [in Devon] on annual leave in late June-21).” He referred to the same incident in the reflection document.

35. On the basis of the documents submitted by the Registrant and the evidence of EF, the Panel finds that the HCPC had discharged the burden of proving particular 3(c).

Particular 4 – Your conduct in relation to Particulars 1 and/or 2 was dishonest in that you knowingly sought to mislead your employer.

36. In reaching its decision on particular 4, the Panel accepted the advice it received that it was necessary to consider dishonesty in relation to particular 1 and particular 2 separately. Furthermore, the Panel was required to reach a decision as to the Registrant’s state of mind in relation to the relevant matters, and then, in the light of that finding, determine whether his conduct was dishonest by the objective standards of ordinary, decent people. If, by reference to the standards of ordinary, decent people, the conduct would be deemed to be dishonest, there would be no requirement to be satisfied that the Registrant appreciated that it was dishonest by those standards.

Particular 1 dishonesty

37. The Panel is of the clear view that it would be known by any qualified Paramedic that an empty bottle that had contained Oramorph should be disposed of properly, and should not be kept for personal use. When interviewed on 1 July 2021, the Registrant stated that he had the empty bottles (he stated he believed it was probably 8 bottles) in order to grow seedlings, qualifying that reply by saying that he did not mean recreational drug seedlings. On 1 July 2021, MC asked the Registrant whether he was growing seedlings at that time, to which the Registrant replied, “Yes”. However, that was not true as, when the bottles were retrieved later that day from the Registrant’s home, they did not contain seedlings nor was there any trace of seedlings having been grown in them. It is not obvious to the Panel how such small bottles could have been used to grow seedlings, but it is unlikely that they would have been used for that purpose as they were discovered unwashed and with the trace of morphine in them. The Panel has no hesitation in finding that the Registrant retained the bottles and took them to his home knowing that he should not have done so. The Panel is also satisfied that ordinary, decent people would view taking used Oramorph bottles home in circumstances where it was known that they should not have been removed, as dishonest behaviour.

38. Accordingly, the Panel finds that the HCPC has discharged the burden of proving that the Registrant’s conduct found proven by particular 1 was dishonest.

Particular 2 dishonesty

39. DW’s email reporting the incident on 21 February 2021, was sent to BK on 26 February 2021. BK spoke to the Registrant the following day, 27 February 2021, and it was on that occasion that the Registrant denied ever intentionally putting them in his bag. That conversation on 27 February 2021 concerned the two bottles that DW saw the Registrant put in his bag, and both particular 2 and this allegation of dishonesty also relate to the same two bottles taken on the same occasion. However, in reaching a decision about the Registrant’s state of mind when he made the denial, it is legitimate to consider whether he had taken other bottles before the date of the conversation in which he uttered the denial. The Panel is satisfied on a balance of probabilities that the Registrant had taken two bottles before the date on which he made the denial. This is because, as already mentioned, one of the bottles retrieved on 1 July 2021, had an expiry date in October 2020, and another had an expiry date in January 2020. The Panel draws the same inference as mentioned above, namely that SCAS would not have issued out of date medication. It follows that those two bottles had been collected by the Registrant before DW saw him take two more to add to his collection on 21 February 2021. The Panel is satisfied that when he denied intentionally putting the bottles into his bag, the Registrant told a deliberate untruth. Ordinary, decent people would consider that to be dishonest behaviour. It follows that the Panel finds that the HCPC has discharged the burden of proving that the Registrant’s behaviour found proven by particular 2 was dishonest.

Decision on Misconduct

40. After the Panel handed down its decision on the facts it allowed time for the Presenting Officer to read it before he made submissions on misconduct and impairment.

41. The Panel had the advantage of the written submissions on misconduct contained in the Presenting Officer’s Case Summary dated 5 August 2024. In oral submissions, the Presenting Officer adopted what had been previously provided in writing and invited the Panel to decide that a finding of misconduct should be made. He submitted that the Registrant’s behaviour breached standards 6.1, 8.1 and 9.1 of the HCPC’s Standards of conduct, performance and ethics. He also referred to standard 2.1 of the Standards of proficiency for Paramedics as it appears in the September 2023 version, and invited the Panel to consider the equivalent provision in the Standards of proficiency as they existed at the time of the relevant events. He submitted that the Panel should approach the matter on the basis that the Registrant’s dishonesty had been repeated. In all the circumstances he invited that the findings made by the Panel should be regarded as a serious falling short of the expectations placed on a Paramedic, and, accordingly, should lead to a finding that misconduct is established.

42. The Panel approached the matter on the basis that it was to consider the facts found proved, and those facts alone.

43. The Panel began its deliberations by deciding whether the Registrant had breached standards with which he was required to comply as an HCPC Registrant. The Panel concluded that he had, and that the following standards were breached:

Of the HCPC’s Standards of conduct, performance and ethics:

Standard 6.1, “You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.” The SCAS policy that Oramorph bottles should be disposed of in the sharps bin had a rationale of mitigating any risk arising from their unsafe disposal. BK outlined one potential risk, namely, that an empty bottle that had contained a potent medication could be re-filled and passed off as the medication it had previously contained. The Registrant’s behaviour in flouting that policy put people at risk by increasing the chances of that being done.

Standard 7.6, “You must acknowledge and act on concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so.” This standard was breached by the Registrant’s behaviour in giving the untrue reply he did to BK on 27 February 2021, and by continuing to retain the empty Oramorph bottles at home, particularly after the importance of disposing them in the sharps bins had been clearly reinforced at the meeting he had with BK on 27 February 2021.

Standard 8.1, “You must be open and honest when something has gone wrong with the care, treatment or other services that you provide by… taking action to put matters right if possible…”. The Registrant was not open and honest, particularly when spoken to by BK on 27 February 2021, and he did not take the opportunity he then had to come clean and return the empty bottles he had retained.

Standard 9.1, “You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.” The Panel is of the view that the Registrant’s behaviour in taking the empty bottles to his home and the untrue denial of having done so made on 27 February 2021, would individually have diminished the trust and confidence in him, even without the finding of dishonesty that the Panel has made in respect of each of those matters. The findings of dishonesty increase the extent to which public trust and confidence would be diminished.

In relation to the findings in particular 3 against the Registrant, both cannabis and cocaine are illicit drugs. The Panel has not lost sight of the fact that its finding is of a single use of cannabis and cocaine, but, the Panel nevertheless considers that the use of those drugs by the Registrant would diminish trust and confidence of members of the public who place their trust in Paramedics at a time of acute vulnerability, and therefore expect high standards of them.

Standard 3.1 of the HCPC’s Standards of proficiency for Paramedics in force at the time of the incidents has been breached. It required the following: “understand the need to maintain high standards of personal and professional conduct.”

44. In reaching its decision, the Panel acknowledged that a finding of misconduct should not be made simply because it has been decided that there have been breaches of HCPC Standards; it is required that an assessment of the seriousness of the breaches that have occurred is required in order to decide if the falling short is serious.

45. The conclusion of the Panel was that the findings of fact made were of sufficient seriousness, and fell far enough below the standards expected of a Paramedic, properly to be described as misconduct. They involved the Registrant taking illicit drugs on 2 occasions and acts of dishonesty in the workplace over several months and in response to direct questioning by his line manager. There is no element of those findings that it would be appropriate to exclude from the finding of misconduct.

Decision on impairment

46. In relation to impairment of fitness to practise, the Presenting Officer indicated in his Case Summary that the Panel would be invited to find that the Registrant’s fitness to practise is impaired on the basis of the risk of repetition, that the misconduct has not been addressed and because a finding of impairment would be needed to declare and uphold proper standards of behaviour and to maintain public confidence in the profession. In oral submissions, the Presenting Officer suggested that the Panel should pose the questions as to whether there is continuing impairment of fitness to practise, whether the public has been, and would in the future be, put at risk by the Registrant’s actions, and what informed members of the public would make of the Registrant’s behaviour.

47. In deciding on current impairment of fitness to practise, the Panel paid close attention to the HCPTS Practice Note on the topic. Accordingly, it accepted that it was required to consider both the personal and public components.

48. In relation to the personal component, the Panel considered the extent to which the Registrant had acknowledged, reflected upon, apologised for and sought to remediate the issues underpinning the Panel’s findings. Having considered this matter, the Panel concluded that there was scant information as to any of these matters.

• In relation to the findings in respect of particular 3(b) & (c), it is fair to record that the Registrant referred himself to the HCPC, and submitted the reflection document. The Panel accepted that these communications represented some insight into those issues. However, it must be recorded that there has been no relevant communication by the Registrant since he submitted the reflection document in December 2021. In the view of the Panel, a registrant who had a real desire to demonstrate remediation would have engaged to a much greater extent and provided further information for the Panel’s consideration to show his current position and the remediation he has undertaken. That he has not sought to do so is demonstrated by the fact that he did not agree to the disclosure of his medical records for consideration by the medical practitioner instructed by the HCPC to give expert evidence in relation to the secondary health allegation.
• So far as particulars 1, 2, and the dishonesty relating to both of them is concerned, there was a complete absence of information provided by the Registrant for the Panel’s consideration.

49. The findings made by the Panel in relation to particulars 1, 2 and 4 are indicative of a practitioner who has a significant attitudinal deficit. Without positive information from the practitioner demonstrating that they understand why matters occurred, why they were inappropriate and what impact they could have had on patients, colleagues and the public, together with reasons why they will not recur, a panel is likely to find itself driven to find that there is a risk that inappropriate behaviour will indeed recur. As a result of the absence of information from the Registrant with regard to the dishonesty found proved and no up to date evidence available to show any remediation, reflection and training he has undertaken since the reflection document submitted in December 2021, the Panel regrettably finds itself in that position. It finds that there is a significant risk of repetition of the misconduct proved.

50. In the judgement of the Panel there is not only a significant risk of repetition, but that in the event of a repetition, there is an unwarranted risk of harm being suffered by others. For that reason, the Panel has concluded that the Registrant’s fitness to practise is currently impaired on the personal component.

51. So far as the public component is concerned, the Panel was satisfied that a finding of current impairment of fitness to practise was required. The risk of repetition gives rise to a risk of future harm to service users. Furthermore, the breaches were serious departures from proper professional conduct, and the Panel would be failing to discharge its duty to uphold proper standards of professional behaviour were it not to find impairment of fitness to practise. Additionally, public confidence in the profession would be diminished were it to be thought that a Paramedic could behave in the manner the Registrant behaved without the regulator taking action.

52. The result of these findings is that the Registrant’s fitness to practise is impaired in respect of both the personal and public components, and the consequence is that the Panel must go on to consider the issue of sanction.

Decision on sanction

53. The Panel informed the Presenting Officer of its decisions on misconduct and impairment of fitness to practise before being addressed by him on sanction. Again, the issue of sanction was touched upon in the Case Summary served in advance of the hearing. In his oral submissions, the Presenting Officer suggested some aggravating and mitigating factors, and made submissions as to the proper approach to reaching a decision on sanction. He repeated a statement made in his Case Summary, namely that the HCPC did not make a positive submission that the Panel should impose any particular sanction, although he did submit that in the light of the finding of dishonesty made by the Panel, any appropriate sanction would be likely to be at the more serious end of the range of available sanctions.

54. The Panel began its deliberations on sanctions by identifying the aggravating and mitigating factors.

The Panel considered the aggravating factors to be:

• the dishonesty found proven;
• the fact that the Registrant’s conduct involved concealment;
• that the breaches continued over many months;
• the complete absence of insight, remorse, apology and remediation into the matters in particulars 1, 2 and 4.

The mitigating factors the Panel was able to identify were:

• the fact that the Registrant had self-referred;
• the Registrant had been open about the matters at 3(b) and 3(c).
• the Registrant cooperated with his line manager BK in relation to the retrieval of the Oramorph bottles referred to in Particular 1.
• the limited insight demonstrated in the reflection sent in December 2021 in relation to particulars 3(b) and 3(c), that insight including some informal admissions.

55. It is important that the Panel should make plain the approach it has taken towards the fact that there has been no comment made by the Registrant at all in relation to the particulars 1, 2 and 4 matters, and only partial insight into particulars 3(b) and 3(c). The Registrant is entitled not to comment on those matters. He is also perfectly within his rights in declining to provide authority for his GP to disclose his medical records to the expert witness instructed by the HCPC. Furthermore, any registrant is at liberty not to attend a hearing concerning them, and, as this Registrant did, to simply send an email in which they contend that the witnesses to be called by the HCPC are lying. The Registrant being entitled to act in all those ways, it would clearly be improper for the Panel to punish him, and the Panel has not done so. But that is not to say that exercising those undoubted rights is without consequence. As will be seen below, the Panel’s does find that they are relevant to the issues of not only whether shortcomings have been remediated to date, but also whether there are realistic grounds for thinking that they might be remediated in the future.

56. The Panel kept in mind a fundamental finding already made by it in relation to impairment of fitness to practise when it addressed the available sanctions. The Panel has already found that there is a significant risk of repetition of behaviour of the sort found proven, and that in the event of it being repeated, there is an unwarranted risk of harm to others.

57. With these findings in mind, the Panel addressed the available sanctions.

58. This is a case that is far too serious to result in no action being taken. Similarly, having considered paragraph 101 of the Sanctions Policy, not only is the case too serious to result in a caution order, but such an outcome would provide no restriction on the Registrant’s ability to practise.

59. The Panel next considered whether a conditions of practice order would be appropriate in this case, and accordingly had regard to paragraph 106. In the Panel’s judgement, a conditions of practice order would not be appropriate because the Registrant has not shown any insight with regards to the dishonesty found proved and therefore no appropriate conditions could be imposed to address this attitudinal issue. Furthermore, the Panel had no information as to the Registrant’s current activities, and his non-engagement in the fitness to practise process means that the Panel could not have confidence that the Registrant would comply with any conditions even if they could be formulated.

60. Accordingly, the Panel next considered a suspension order. Paragraph 121 of the Sanctions Policy includes the following:
“A suspension order is likely to be appropriate where there are serious concerns which cannot reasonably be addressed by a conditions of practice order, but which do not require the registrant to be struck off the Register. These types of cases will typically exhibit the following factors:

• the concerns represent a serious breach of the Standards of conduct, performance and ethics;
• the registrant has insight;
• the issues are unlikely to be repeated; and
• there is evidence to suggest the registrant is likely to be able to resolve or remedy their failings.”

61. Applying the circumstances to this case to the factors suggested in paragraph 121:

• the concerns in the present case do represent serious breaches of the Standards of conduct, performance and ethics;
• the Registrant has not shown the Panel any evidence of insight regarding the dishonesty allegation found proved;
• the issues are likely to be repeated, (as a consequence of the Registrant not having shown to the Panel any evidence of insight into the issues found proved, especially regarding dishonesty);
• there is no evidence before the Panel to suggest that the Registrant will be able (or willing) to resolve his failings.

The fact that the present case did not fit the suggested factors resulted in the Panel considering whether a striking-off order should be made.

62. Paragraph 130 of the Sanctions Policy reminds panels that a striking-off order is a sanction of last resort for serious, persistent, deliberate or reckless acts. Cases of dishonesty are included in the non-exhaustive list of the types of case that might be expected to result in striking off. Paragraph 131 then follows as follows:

“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:

• lacks insight;
• continues to repeat the misconduct…;
• is unwilling to resolve matters.”

63. Applying the circumstances of this case to these factors:

• the Registrant does lack insight;
• the misconduct found to be dishonest was repeated within the time frame of the allegations, albeit that it has not been repeated since;
• as it is now more than three years since the relevant events, and the Registrant has not provided any evidence that suggests that he is minded to resolve matters, it is a legitimate inference to draw that he is unwilling to do so.

64. The position facing the Panel is therefore that, by the application of the Sanctions Policy, a suspension order is not suggested, whereas a striking-off order is. However, before confirming that a striking-off order should be made, the Panel considered that it would need to be satisfied that it would be proportionate to do so.

65. In the view of the Panel the findings made in this case are not of a nature where the only sanction that could be contemplated would be that of striking-off. Had the Registrant engaged and demonstrated successful remediation, it would be possible to imagine a sanction that would have enabled him to return to practise as a Paramedic. If he had engaged and demonstrated that he was taking meaningful steps towards remediation, then even if he had not yet achieved sufficient remediation to enable him to return immediately to practise, then a sanction allowing him further time to develop his remediation could be envisaged.

66. However, the problem in the present case is that, for reasons already explained, the lack of information from the Registrant as to his current insight and remediation and the inability of the Panel to question him regarding [redacted] the risk of repetition with attendant risk of harm found by the Panel, means that the potential for imposing a sanction to allow the Registrant to practise is unfortunately not possible.

67. In the judgement of the Panel there would be no point in making a suspension order because there are no grounds for believing that the position on a review of the order at the end of the period of suspension ordered would be any different from the position now. The fact that the Registrant has had 3 years to provide such information and has chosen not to, does not provide reason or grounds for the Panel to afford him a further period of time so to do. For that reason, the Panel has concluded that the making of a Striking-Off Order at the present time represents a proportionate response to the findings made.

Secondary health allegation

68. As stated in the Panel’s determination, the Investigating Committee referred a dual allegation. As also stated, in dealing with the primary, misconduct allegation, the Panel applied the guidance contained in the HCPC’s document headed, “Approach to dual allegations” revised in June 2021. The sanction imposed by the Panel in respect of the primary allegation it has been considering was a striking-off order. Accordingly, consistent with the guidance contained in the final paragraph of the guidance document, as the Panel has imposed a Striking-Off Order in relation to the primary allegation, it is not necessary for it to make any direction in relation to the health allegation as the health allegation will fall away.

Order: The Registrar is directed strike the name of Jeremy Bailey from the Register on the date this Order comes into effect.

Interim Order

Application

1. After the Panel announced its decision that the sanction in this case would be that of striking-off, the Presenting Officer applied for an interim order to cover the appeal period. He submitted that such an order should be made is necessary for protection of members of the public and is otherwise in the public interest, and that the reasons why those statutory grounds are met are those explained by the Panel in its substantive sanction decision.

Decision

2. The Panel accepted the advice it received from the Legal Assessor in relation to the application under consideration. Accordingly, the Panel considered the following matters in the following order:

• First, whether the Panel has jurisdiction to consider the issue;
• Secondly, if there is jurisdiction to consider the application, whether it is appropriate to deal with the application in the absence of the Registrant;
• Finally, to consider the merits of the application. Any risks presented by the Registrant were required to be measured by reference to the three grounds that can justify the making of an interim order. The three grounds are, (i) that it is necessary for protection of members of the public, (ii) that it is otherwise in the public interest, and (iii) that it is in the interests of the Registrant himself. If one or more of those three grounds were engaged, the Panel should consider whether, notwithstanding the fact that substantive conditions of practice have been rejected as an appropriate sanction, the identified risks could properly be addressed by the imposition of interim conditions of practice.

3. The Panel was satisfied that it had jurisdiction to consider the application. Included in the Notice of Hearing email sent to the Registrant on 15 May 2024, was the following paragraph, “Please note that if the Panel finds that it is necessary to do so, it may also impose an interim order (under Article 31of the Health Professions Order 2001) at any stage during the hearing. An interim order suspends or restricts a registrant’s right to practise with immediate effect.” In the judgement of the Panel this statement afforded the Registrant with the opportunity to address the application for an interim order, and accordingly provided the Panel with the jurisdiction to consider the application.

4. The Panel was satisfied that it was appropriate to deal with the application in the absence of the Registrant. By the communication to which reference has already been made, the Registrant had been informed that the application might be made. There were no grounds on which the Panel could conclude that there was any likelihood that the Registrant would participate in the hearing to address the application on a future occasion were the issue not decided at present. Furthermore, when the HCPC submits that an interim order is required, the nature of that application is such that the public interest demands that the application should be decided expeditiously.

5. So far as the merits of the application were concerned, the Panel applied the findings it had already made in its substantive decision. The Registrant presents a risk of repeating behaviour of the sort found proved by the Panel. That behaviour, if repeated, would create an unacceptable risk to the public, and, for that reason, the Registrant cannot be permitted to return to unrestricted practice as a Paramedic. It follows from these findings that an interim order is necessary for protection of members of the public and, because of the public perception of the risk he would present, is also required in the public interest. For the avoidance of doubt, the Panel does not consider that an interim order is necessary in the Registrant’s own interests.

6. The Panel considered whether the restriction on the Registrant’s ability to practise as a Paramedic could be provided by the imposition of interim conditions of practice. For the reasons already explained by the Panel in its sanction decision for rejecting substantive conditions of practice, it also decided that interim conditions of practice would not satisfactorily address the risks presented while the Registrant’s appeal rights remained extant.

7. For these reasons, the Panel concluded that an Interim Suspension Order should be imposed. The Panel decided that it should be imposed for the maximum period of 18 months. That period is proportionate because it will simply fall away if the period within which the Registrant can commence an appeal passes without him doing so. If, on the other hand, the Registrant does appeal, then it could be 18 months before it is finally determined.

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 Jeremy Bailey