Mr M, paramedic, ambulance driver.

Mr M, had written to the HPC last year telling them that he had stopped working as a paramedic and asking to be removed from the register. It did not respond. He wrote again this year reminding it, again without success. He wrote to the law firm acting on behalf of the HPC in today’s fitness to practice hearing pointing out that to proceed with the hearing against him was a waste of time and money. In a rather touching move he added ‘I know the ball is rolling now, and that you say it is impossible to stop’, but again stressed the waste of time, and of tax payers’ money.

Nevertheless, the HPC takes its duty seriously. Its public, apparently, deserves its pound of flesh.

In the little bit of time that emerged as the system waited for the actors to show up, the HPC solicitor bantered with the legal adviser. She read out: " It says "Mr M has been working for 25 years without a single incident" she smirked as she added the word ‘reported’. It seemed pretty clear that she interpreted his absence and his letter as an admission of his guilt and an attempt to worm his way out of the humiliation. From the public benches it seemed at least equally likely that he had no faith in the fairness of the system and wanted not to become grist to this mill.

The complaint about Mr P’s work was made by Mr D: an instructor and sectional training manager and 'responsible', as he pointed out, ‘for Mr P being up to date’. He happened to be at the scene when the ambulance arrived, and he saw that Mr P was driving it.

Of course, it is not a crime for an ambulance driver to drive an ambulance. The crime this time was in delegating responsibility to the two other workers who remained in the back of the ambulance during the 6 minute journey to the hospital. One of these workers was a witness at this morning’s hearing.

She has worked for the service for 20 years, and is an emergency medicine technician. She had no doubts whatsoever about her team’s competence to work safely with the patient that day. But it was also her opinion that a paramedic on the team should stay with the patient and delegate the driving to a non-paramedic. This was her opinion, she repeated, though she knew that everyone had their own ideas.

It was her opinion and not that of the man in charge at the scene. Nevertheless her opinion is matched by that also written in some rule-books. It is written in a liaison committee’s guidelines, and appears in the European Resuscitation Council’s guidelines. These ‘guidelines’, however, are not open for discussion. Which is surprising, for guidelines.

The process appears to proceed like a giant unstoppable machine, yet the machinery is made up of people and bits of paper. Many of the people concerned would call themselves ‘professionals’, which implies that they are trusted to exercise their personal judgement. Their judgement and their actions can surely be subject to debate.

The real nature of the scene in question again seemed un-interesting to the HPC. The nitty gritty business of driving an ambulance, intervening in real life traumas and crises, and of making decisions about another man’s life is reduced to what is written in a few pre-printed books. What is at stake is whether the man’s character can be read from the way he relates to the administration. From this distance, it looks very much as if the HPC is a very heavy sledge hammer used to force a centralised rule book into the bodies and minds of local ambulance drivers.

It was Karl Popper who remarked that ‘you can centralise all power, but you cannot centralise all knowledge’. He knew, however, that sometimes, and especially in bad times, some people like to try.

Perhaps Mr P was a dangerous man, perhaps it is right that after 20 years of unblemished service, he should no longer be paid to save people’s lives. Perhaps. But the way that the case is being pursued is running roughshod over important questions and values and leaves a lot of useful knowledge and insight stumbling around in the dark.

My question, as before, is what kind of public is being imagined in order to justify this work of the HPC? It is not one that I am familiar with. And what kind of peril is it being saved from. From an ordinary, yet educated point of view available in the public benches, what can be seen as taking shape is quite a different danger. It is this that needs to be brought to light if we are serious about protecting a real public from the real danger - of creating something pernicious.

I await the publication of the panel’s conclusion, and will report on it tomorrow