PAUL HAWKER v THE HEALTH AND CARE PROFESSIONS COUNCIL

On an appeal from a professional disciplinary tribunal, the High Court must decide whether the decision was wrong. It is not bound by the tribunal’s conclusions and may substitute a different sanction where appropriate. However, substantial weight is due to the tribunal’s specialist expertise, its assessment of professional standards, and its opportunity to hear the evidence.

Insight and risk of repetition are distinct questions. Lack of insight is not automatically equivalent to a risk of repetition, but may be highly relevant to that risk. A tribunal may treat denial of misconduct as evidence bearing on insight, provided it does not treat denial as conclusive. A severe sanction, including striking off, is not disproportionate merely because a lesser sanction was available.

The appellant, a registered paramedic, appealed under article 29(9) of the Health and Social Work Professions Order 2001 against a decision of the Health and Care Professions Tribunal Service’s Conduct and Competence Committee.

The Panel found that, while working for an ambulance service, he failed adequately to assess a woman apparently suffering a stroke and walked away after 48 seconds. It found misconduct, impairment of fitness to practise on both the personal and public components, and imposed striking off under article 29(5).

The appeal challenged the proportionality of the sanction, the Panel’s treatment of insight and risk of repetition, alleged double-counting of aggravating features, and its characterisation of the appellant’s conduct.

1. The appeal was dismissed. The court’s function was to determine whether the Panel’s decision was wrong. It could consider whether striking off was appropriate and necessary or excessive and disproportionate, while giving appropriate weight to the Panel’s specialist knowledge, its assessment of professional standards and public confidence, and its advantage in hearing the witnesses. The approach was derived from Ghosh v General Medical Council [2001] UKPC 29, The Professional Standards Authority v The Health & Care Professions Council (Doree) [2017] EWCA Civ 319, and Bawa-Garba v General Medical Council [2018] EWCA Civ 1879.

2. The Panel had not impermissibly double-counted the seriousness of the conduct. The matters listed as aggravating features were, viewed in context, aspects of the gravity of the misconduct rather than sentencing-style factors added to an established starting point. The additional reference to failure to work with colleagues was minor and did not materially affect the outcome.

3. Insight and risk of repetition were distinct, although closely connected. Lack of insight could be a potent indication of a risk of repetition, but neither proposition was automatic. The Panel was entitled to consider the appellant’s denial, the adverse findings about his evidence, and his later focus on clinical stroke-recognition skills rather than the attitudinal failing of walking away without assessment. The reasoning was consistent with R (Bevan) v General Medical Council [2005] EWHC 174 (Admin), and the other authorities cited concerning denial and insight.

4. The Panel’s description of the incident did not materially mischaracterise the misconduct. The essential finding was that the appellant knowingly walked away despite being told of a concern that the woman might be suffering a stroke, without undertaking an assessment. The distinction between failing to recognise a stroke because no assessment was made and failing to recognise it after an assessment was immaterial in the circumstances.

5. Striking off was severe, particularly given the appellant’s otherwise unblemished career, continuing work without further incident, remorse and good testimonials. Nevertheless, the seriousness of abandoning a vulnerable person in potentially time-critical circumstances, together with the findings of insufficient insight and risk of repetition, meant that striking off was within the range of sanctions properly open to the Panel.

• High Court (Administrative Court): appeal against the Panel’s decision dismissed.