Karl Hough v Health and Care Professions Tribunal Service

On an appeal from a professional disciplinary decision, the court may intervene only where the decision was wrong or unjust because of serious procedural or other irregularity. It must respect the specialist expertise of the regulatory tribunal and its advantage in hearing live evidence, while independently reviewing the appropriateness and proportionality of sanction.

Insight is principally relevant to future risk. A practitioner may contest the allegations, but the tribunal may consider the practitioner’s attitude to the underlying conduct when assessing insight and the risk of repetition. Sanction is fact-specific and regulatory protection of the public takes priority over retributive considerations. A striking-off order may be proportionate where serious misconduct, dishonesty, incomplete insight and a continuing risk mean that lesser sanctions would not adequately protect the public.

The claimant appealed under article 29(9) of the Health Professions Order 2001 against a Conduct and Competence Committee decision dated 28 March 2025. The Panel found multiple allegations proved concerning the treatment and recording of care provided to two acutely unwell patients. The findings included misconduct, dishonesty and current impairment of fitness to practise, and resulted in a striking-off order.

The appeal challenged the Panel’s factual findings, findings of misconduct and impairment, and sanction. The central issues were the proper appellate approach to professional tribunal decisions, the effect of the claimant’s denial on the assessment of insight and future risk, and whether striking off was proportionate.

1. The appeal was dismissed. The Court’s powers arose under article 38(3) of the Health Professions Order 2001, and the appeal test was that in CPR 52.21(3): whether the decision was wrong or unjust because of a serious procedural or other irregularity.
2. Findings of primary fact should be approached with considerable deference. The appellate court should be slow to interfere, particularly where the Panel heard the witnesses and had specialist professional expertise. Intervention is justified in exceptional circumstances, including where findings are irrational, unsupported by evidence, materially affected by irrelevant considerations, or plainly out of tune with the evidence. The Panel had carefully assessed the witnesses, the alleged inconsistencies and the claimant’s own evidence. No such circumstances existed.
3. The dishonesty finding was open to the Panel. It was entitled to accept that authority under a patient group direction could not be delegated, that the claimant knew this, and that recording himself as having administered midazolam was intended to conceal its administration by an unauthorised colleague.
4. In assessing impairment, the Panel correctly treated insight as relevant to future risk rather than as punishment for denial. Although the claimant was entitled to contest the allegations, his attitude towards the underlying conduct was relevant to whether he understood the seriousness of his actions and whether the attitudinal shortcoming identified by the Panel was likely to recur. The assessment of insight was principally for the Panel, which had heard the claimant’s evidence at length.
5. Sanction was a multifactorial evaluative decision with limited scope for appellate intervention. The Panel properly balanced the claimant’s career, testimonials, admissions, engagement and subsequent work against the two incidents, dishonesty, risks to vulnerable patients, failure to work in partnership and incomplete insight. The suspension criteria in the Sanctions Policy were not met because insight was limited and recurrence could not be discounted. The Panel was entitled to conclude that striking off was the only proportionate sanction.
6. The claimant was ordered to pay the defendant’s costs under CPR 44.2(2)(a), summarily assessed at £7,017.60, with six months allowed for payment.

• Conduct and Competence Committee of the Health and Care Professions Council: found misconduct, current impairment of fitness to practise and directed striking off on 28 March 2025.
• High Court (Administrative Court): dismissed the appeal under article 38(3) of the Health Professions Order 2001.