High Court upholds strike-off for paramedic found to have been dishonest and lacking insight

In Hough v Health and Care Professions Tribunal Service [2026] EWHC 743 (Admin), the High Court reaffirmed that it will rarely interfere with the factual findings of a professional disciplinary tribunal, who are best placed to make decisions having heard the evidence first hand. It also reinforced the strict approach taken in fitness to practise cases, particularly where dishonesty and lack of insight are apparent.

The facts

The Registrant was an Advanced Paramedic with over 30 years’ experience. The allegations arose out of two separate incidents.

The first, on 14 March 2018, involved Patient A, a child with a rare neurological condition. On the day in question, Patient A’s oxygen saturation levels were of concern, and Witness 1, a Highly Specialised Community Respiratory Physiotherapist, decided Patient A’s Emergency Treatment Plan should be followed. This involved calling 999. The Registrant arrived after a first ambulance and it is alleged that upon arrival, he failed properly to communicate or engage with Witness 1 and he made errors in terms of proper infection control and record keeping/communication with other medical teams.

The second incident arose on 11 July 2020 in respect of Patient D, who had suffered a cardiac arrest. The Registrant arrived with a senior paramedic after two ambulances. It was alleged that the Registrant inappropriately administered and/or directed to be administered medications to the patient, made a clinical error in respect of Patient D’s oxygen mask and made false or inaccurate records in relation to Patient D, including one allegation that he recorded he had administered a medication to the patient when that was not the case, which was dishonest.

The HCPTS hearing

At the Final Hearing, the Panel found the majority of the allegations proved, some of which had been admitted by the Registrant, and some having been found proved.

The Panel then decided that the allegations proven against the Registrant amounted to misconduct. They concluded that this was not a case in which the Registrant was not able to perform differently; rather this was a case in which the Registrant had chosen not to perform in a manner that he was able to. The Panel noted that some of the factual findings, namely the dishonesty and administrations of inappropriate and excessive quantities of medication were particularly serious.

The Panel then found that the Registrant’s fitness to practise was impaired. The Panel concluded that the root of the issues in the case was an “attitudinal shortcoming” on behalf of the Registrant, and he failed to have a true understanding of how inappropriate his actions were. They did not have concerns about his ability to practise safely and effectively, but said there was a significant risk that his character is such that he would choose to act outside clinical standards and professional expectations in the future.

The Panel decided that the only sanction appropriate was a striking off order.

The Registrant appealed the decision to the High Court on a number of grounds.

The appeal

Ground 1: the Panel’s finding of fact

The Registrant argued that the Panel’s decisions in respect of the facts were not well-founded and there was no proper consideration of the weight of the evidence presented.

The High Court reiterated the caselaw that an appellate Court will only allow an appeal against a finding of fact in exceptional circumstances, namely where the finding of fact is irrational or such that no reasonable Panel could have made it or it was made taking into account irrelevant matters or not considering relevant matters. Further, deference should be shown to the expertise and experience of a professional Panel in professional regulatory appeals, who have had the benefit of assessing the live evidence before them, of which the appellate Court has not had the advantage.

The High Court concluded that none of the exceptional circumstances were present and there was no basis for interfering with the Panel’s findings of facts. Mr Justice Hill found that the Panel had given sufficient reasoning, which was reasonable, as to why they had found the facts proven. As such, ground 1 was dismissed.

Ground 2: misconduct

The Registrant argued that the Panel’s finding of misconduct was unreasonable for a range of reasons.

As above, the High Court concluded that the Panel had given proper reasons for its finding of misconduct, and it was appropriate to give deference to the Panel’s expertise and having assessed the live evidence before it. As such, it concluded there was no basis for interfering with the Panel’s findings and so dismissed ground 2.

Ground 3: impairment

The Registrant contended that the Panel’s decision with respect to impairment was wrong.

The High Court reiterated that caselaw, as summarised by Sayer v General Osteopathic Council [2021] EWHC 370 (Admin) set out the following principles in relation to insight where a Registrant has denied the allegations:

1. Insight is concerned with future risk of repetition. It is to be distinguished between remorse for past behaviour.
2. Denial of misconduct is not a reason to increase sanction.
3. Denial of misconduct is not a bar to a finding of insight, and admitting misconduct is not a prerequisite to a finding of insight; it is about establishing that the Registrant understands the gravity of the behaviour and is unlikely to repeat it.
4. Attitude to the allegations is a proper consideration when weighing up insight.
5. The assessment of insight is a matter for the tribunal, having heard all the evidence and from the Registrant. The Court should be slow to interfere.

The High Court explained that the Panel’s finding on impairment was predominantly concerned with the Registrant’s “attitudinal shortcoming” and that their assessment of the Registrant was that this was unlikely to change. They were concerned he did not have a real understanding of the seriousness of his actions and did not accept any wrongdoing. As a result, the High Court concluded that the Panel’s reasons demonstrated a sound and logical basis for concluding that the Registrant’s fitness to practise was currently impaired. As such, it concluded that the Panel’s decision on impairment was not wrong and so dismissed ground 3.

Ground 4: sanction

The Registrant argued that the sanction imposed was disproportionate.

The High Court confirmed that there is limited scope for an appellate Court to overturn a decision on sanction. Further, the decision on sanction is very much a fact-specific exercise, and so most caselaw is of limited assistance in this regard. It concluded that the Panel gave full and well-reasoned explanations for its decision to strike the Registrant off the register. In particular, they were justified in concluding that three of the factors in the HCPC Sanctions Policy that may justify a striking off order were present; being dishonesty, a failure to work in partnership and this being a case 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. As such, it found no proper basis upon which to interfere with the Panel’s decision and dismissed ground 4.

The High Court therefore dismissed the Registrant’s appeal on all four grounds.

Comment

This case highlights that appellate Courts will be slow to interfere with decisions made by regulatory tribunals. The High Court was clear in that these specialist tribunals are best placed to assess evidence and credibility, and make decisions on facts, grounds, impairment and sanction on that basis. There is a high threshold to interfere with tribunal decisions, particularly where findings of dishonesty are involved. Further, a sanction will only be interfered with where it is clearly disproportionate in relation to the facts of the specific case.

It is also a reminder that professional regulation is about protecting future patients. The High Court’s judgment reinforces that when a practitioner’s conduct reveals deep‑seated attitudinal problems, and when insight is limited or absent, the regulator’s ultimate sanction may be the only safe option.

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