Rex Hall

Park House tel +44 (0300 500 6184 health & care
184-186 Kennington Park Read — fax +44 (0}20 7820 9684 professions
London SE11 4BU www.hcope-uk.org council

Mrs Louise Hunt

Senior HM Coroner
Birmingham and Solihull Areas
50 Newton Street

Birmingham

B4 6NE

Your re: 115215 - REX BROOK HALL (EB/RP)

2 December 2019
Dear Mrs Hunt
Rex Brook Hall — Deceased

| am writing further to your letter of 20 November 2019, addressed to Marc Seale,
concerning the HCPC’s response to the Report to Prevent Future Deaths sent on 29
November 2016. | am responding as Mr Seale is no longer the Chief Executive of the
HCPC.

| must first apologise that | have not been able to retrieve a copy of any response
send to 2016/2017. In view of this please find a response to the actions taken
relevant to the matters of concern raised.

We note the concerns raised regarding foundation level training for paramedics. We
have taken significant steps within the sector to support the development of
paramedic practice. In particular, in March 2018 we determined it necessary to raise
the threshold level of entry to the Register to degree level (levels 6/9/10 on the
relevant UK qualifications frameworks). The threshold level for entry to the Register
for paramedics was changed to degree level for the following reasons:

e A large majority of respondents to the public consultation argued that degree
level was necessary for safe and effective contemporary practice.

e The profile of paramedic education and training has continued to develop —
Degree level programmes now account for almost half of all approved
paramedic programmes.

e Degree level education and training is necessary to deliver the Standards of
proficiency to the depth required for contemporary paramedic practice (see
bullet point above). The descriptors of qualifications at level 6/9/10 articulate
requirements for ‘personal responsibility’ and decision making in ‘complex and
unpredictable circumstances’ which is consistent with what stakeholders told
us about the contemporary requirements of paramedics in practice.

Whilst there were no significant changes to the standards of proficiency (SOPs)
themselves, the nature of paramedic practice necessitated a raising of the level of
learning required to achieve them, as articulated by the revised threshold level of
entry. It is important to note that this change would not affect any current registrants
who will not have trained to the new level. The new level will be applied from
September 2021, at which point all training routes into the paramedic profession will
be set at degree level (or equivalent).

The SOPs for paramedics set out the knowledge, skills and abilities individuals must
meet and maintain to register with us, and practice safely and effectively as a
paramedic. These standards have been revised periodically, to ensure they remain
relevant to current practice for the paramedic profession. In relation to the specific
points regarding the training of the paramedics in question, the SOPs for paramedics
include specific reference to the need for paramedics to:

e understand the structure and function of the human body, together with
knowledge of health, disease, disorder and dysfunction, relevant to the
paramedic profession (13.1)

e understand the following aspects of biological science, including: human
anatomy and physiology, especially the dynamic relationships of human
structure and function and the musculoskeletal, cardiovascular, respiratory,
digestive, endocrine, urinary, reproductive, integumentary and nervous
systems (13.8)

e understand the following aspects of clinical science, including: pathological
changes and related clinical features of conditions encountered in pre-hospital
and out-of-hospital practice & physiological, pharmacological, structural,
behavioural and functional changes in patient presentation (13.11)

e be able to conduct appropriate diagnostic or monitoring procedures,
treatment, therapy or other actions safely and effectively (14.3)

e be able to conduct a thorough and detailed physical examination of the patient
using appropriate skills to inform clinical reasoning and guide the formulation
of a differential diagnosis across all age ranges (14.12)

The SOPs were last revised and republished in 2014, and are applied to all levels of
training currently in existence (and in existence at the time of the events in question),
including any of those set at Foundation degree level. We approve education and
training programmes that can demonstrate their curriculum and assessment ensures
that all individuals who receive the final award leading HCPC registration have
successfully met all the SOPs (including those highlighted above). It is on this basis

that all individuals are deemed eligible to apply with us for registration. Once
registered, all registrants must continue to maintain their adherence to these
standards to remain on the register, including showing evidence of their continuing
professional development if audited. We are currently undertaking a review of the
SOPs and will liaise with the College of Paramedics on the concerns raised in your
report to explore whether any amendments should be made in this regard.

Where specific concerns are raised around an identifiable registrant's practice, we
can investigate and if necessary consider their fitness to practise further. We can
also investigate identified approved education and training providers, if there were
concerns raised about the teaching and learning being provided. Should any
specific concerns be raised as a result of your investigation, we will consider these
and take appropriate action.

Yours sincerely

Ze Book

John Barwick
Interim Chief Executive and Deputy Registrar