Helen J Stokes

Preliminary Matters

Service

1. The Registrant was served with notice of the hearing on 19 August 2022 by email.

2. The Panel accepted the advice of the Legal Assessor, and was satisfied that the Notice of Hearing had been served in accordance with Rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (the Rules).

Private Hearing

3. The papers contained references to the Registrant’s health and private life. There was an application by Ms Khorassani for those parts of the hearing to be heard in private. She submitted that despite the presumption in favour of public hearings, in accordance with Rule 10(1)(a) of the Rules, the Panel could exercise its discretion to hear all or part of a case in private where it is in the interests of justice to do so or where the evidence relates to the private life of the

4. The Panel accepted the advice of the Legal Assessor.

5. Having balanced the competing interests, the Panel considered that it was in the interests of justice for those parts of the hearing relating to the Registrant’s private life to be held in private. This was consistent with the approach at the substantive hearing, the first review in December 2020 and the second review in December 2021.

Proceeding in the absence of the Registrant

6. The Panel then went on to consider whether to proceed in the absence of the Registrant pursuant to Rule 11 of the

7. In doing so, it considered the submissions of Ms Khorassani on behalf of the HCPC. She submitted that the Panel should proceed to hear the case because the Registrant had not applied for an adjournment and had indicated that she did not wish to participate in the hearing; there was no indication that the Registrant would attend on any future There was, she submitted, a public interest in this matter being dealt with in a timely manner particularly as this is a mandatory review of an order that will expire in October 2022.

8. The Panel accepted the advice of the Legal

9. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC Practice Note ‘Proceeding in the Absence of the Registrant’ dated June 2022.

10. In reaching its decision the Panel considered the following: she had made no request to adjourn the Her engagement in the process leading to this hearing had been minimal and there was no indication that an adjournment would be likely to secure her attendance at any future hearing. There is a clear public interest in the matter proceeding, this being a mandatory review of an existing order.

11. Having weighed all matters, including the public interest in the expeditious disposal of this case, the Panel determined to proceed in the Registrant’s

Background

12. At the material time, the Registrant, who started work as a Physiotherapist in 2005, was working as a specialist Physiotherapist in the Falls Team at the North Somerset Community Partnership (NSCP). In about January 2017 the Registrant was seriously injured in a road traffic accident. Amongst other matters, her mobility was seriously

13. In clearing out the Registrant’s home after this accident, notes and records relating to service users and colleagues were discovered that the Registrant had been keeping in her home. Some of the records dated back to a period in excess of 10 years.

14. The notes were returned to the NSCP and, by a process of cross referral, it was discovered that they related to a total of 277 patients and the names of 418 patients that appeared within the documentation which also included the names of staff. There was no suggestion, however, that any patient had suffered

15. On 6 October 2017, the NSCP referred the Registrant to the

16. The Final Hearing of this case took place on 18-19 December 2019 in the absence of the Registrant. She had previously emailed the HCPC to state that she was unwell. She added in that same email that she had no desire to return to practice and wanted her name removed from the Register.

17. During the course of the investigation conducted by the NSCP the Registrant had admitted that she should not have kept the documents in her home. This acceptance formed part of the panel’s reasons in finding the factual particular (particular 1) proved.

18. In further finding misconduct the Substantive Panel took the view that the failure of the Registrant to maintain confidentiality and keep the records safe betrayed a fundamental tenet of the role of a

19. Other reasons given for finding misconduct included the sheer volume of notes stored at the Registrant’s home and the extended time period over which they had accumulated.

20. A finding of impairment followed in relation both to the personal and public components. The Registrant had never, in the view of the Substantive Panel, fully appreciated the gravity of the situation and the serious implications for service users and her employer as a result of these failures.

21. In dealing with the topic of impairment, although the Substantive Panel determined that the Registrant’s actions were remediable, there was no actual evidence of any action taken by the Registrant to demonstrate that she had achieved remediation. Nor, the Substantive Panel found, was there evidence that the Registrant had kept up to date with statutory, mandatory, annual training in relation to information governance since 2015. As such, the Substantive Panel found that the Registrant’s insight, at best, was limited, that her failings had not been remediated and that the risk of repetition remained high.

22. In respect of the public component, the Substantive Panel’s view was that the volume of material recovered and the period of time involved was so significant that the Registrant’s misconduct was such that a finding of impairment was necessary in order to uphold professional standards and public confidence in the profession.

23. The Substantive Panel determined that the only appropriate and proportionate response to protect the public and the wider public interest was to make a 12 month suspension order.

The First Review

24. On 24 November 2020 and prior to the first review on 8 December 2020, the Registrant engaged with the She emailed to the HCPC a

reflective piece in which she accepted that her fitness to practise had been impaired at the material time. She stated her belief that all the issues that affected her then had now been resolved. She catalogued them and blamed her failure to return some of the documents to the workplace on the near fatal car accident that she had suffered. She complained of being bullied at work and claimed a lack of support from her line manager. To this she added details of problems that afflicted her at the time.

25. In the first review, she emphasised that all her problems now had been resolved. Furthermore, she provided information about her employment as a domiciliary care worker for Blue Sky Enabling (BSE) and as a live- in carer for Flexicare Within this same document she declared that she had completed her care certificate and nearly finished a City and Guilds Level 3 qualification in Adult Social Care. Attached to this email was a BSE self-appraisal dated 29 January 2020.

26. The Registrant emailed a second reflective piece to the Review Panel in which she expressed remorse for her failings. She also amended her original proposal not to return to her profession and emphasised a newfound desire to work as a Disability

27. The Registrant gave evidence on oath to the first Review Panel. She repeated details of the health problems she had been suffering from, but said these were now matters in the past. She expressed deep remorse and shame for her misconduct. She added that she now possessed greater She further told the Panel that she was now well aware of the importance of confidentiality and that she was blessed with a very supportive husband and a number of close friends. She did accept that she had done no Physiotherapy-related CPD over the past 12 months, although she had read up on a number of topics.

28. However, the Review Panel noted that “……the Registrant is genuinely remorseful and ashamed of what she As against that, however the Panel could not ignore the aggravating factors that persist in this case. In dealing with the personal component the Panel shares the views of those of the previous panel in concluding that the Registrant has not demonstrated full insight yet and the risk of repetition continues to exist. Any plans she may have for her work future are unformulated. No outside references have been produced to the Panel. In relation to the public component, again this Panel agrees with what was previously said about the seriousness of the sheer volume of breaches of

confidentiality that this case has exposed. Many of the documents wrongly stored at the Registrant’s home were mixed with other personal papers and the sheer number of years that this took place over was a pertinent factor to consider in this context. Thus, the Panel found that the Registrant’s fitness to practise was still impaired.”

29. The Review Panel determined that the appropriate and proportionate sanction was to extend the Suspension Order for a further period of 12 months.

The Second Review

30. At the second review hearing on 13 December 2021, the Review Panel noted that after the first review, the Registrant did not engage further in any manner with the HCPTS. She offered no response to the first Review Panel recommendations. No outside references or evidence of current up-to-date training was provided to the Panel. In the absence of any information as to what the Registrant may be currently doing, or what her plans were and how she had remedied her practice, the Review Panel concluded that her fitness to practise remained impaired.

31. In relation to the public component, the Panel agreed with what was previously said about the seriousness of the breaches of confidentiality in this case. Many of the documents wrongly stored at the Registrant’s home were mixed with other personal papers and the storage continued for a number of years. In the absence of any evidence from the Registrant the Panel also found that the Registrant’s fitness to practise remained impaired on public interest grounds.

32. The Panel considered what, if any, sanction to impose and referred to the HCPTS Sanction Policy. The taking of no further action, mediation or a caution order were not appropriate due to the serious nature of the

33. In considering whether to impose a Conditions of Practice Order the Panel’s view was that this would not be appropriate, workable or measurable. The Registrant had not engaged since the December 2020 review and had not actioned any of the recommendations of the December 2020 review hearing and in those circumstances a Conditions of Practice Order was unworkable.

34. In the circumstances, the Panel determined that the appropriate and proportionate sanction was to extend the existing Order of Suspension for a further period of 9 months thereby allowing the Registrant an opportunity to engage and to show she can develop real insight and remedied her The Panel noted a number of practical steps that the Registrant could take, notwithstanding she has been out of practice, to assist a future Panel to determine whether her fitness to practise is no longer impaired and that she can practise safely as a physiotherapist if that is indeed her intention. These could include:

• Engagement with the regulatory process and her attendance at the next hearing

• Testimonial evidence from paid or unpaid employment

• Evidence of keeping up to date with her clinical skills

• A Personal Development Plan to inform her learning in relation to the requirements of standards 1,2,3 and 4 contained within the document entitled ‘Continuing Professional Development and your Registration’.

• Evidence/certificates of any relevant continuing professional development relating in particular to confidentiality and information governance.

35. The second review panel noted the possibility of strike off in this case but determined that at that stage such an order would be However, if the Registrant continued to disengage it would be an option to be considered by the next reviewing Panel.

Decision

36. This Panel considered all the material before it and the submissions made by Ms Khorassani. It accepted the advice of the Legal It had regard to the HCPTS Practice Notes “Fitness to Practise Impairment’ dated February 2022 and “Review of Article 30 Sanction Orders” dated June 2018.

37. The Panel noted that, in response to being given notice of this hearing, the Registrant emailed the HCPTS on 5 September 2022 indicating she had retired and had no wish or intention to return to practice.  Given her circumstances, the Registrant described this regulatory process as a “waste of resources”.    

38. The Panel took into account that there is a “persuasive burden” upon the Registrant to demonstrate that she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently.

39. The Panel noted that, apart from the email on 5 September 2022, the Registrant has not engaged with the HCPC since the review conducted in December 2020, and has not provided evidence of any action taken with respect to any of the recommendations made by reviewing Panels in December 2020 or December 2021.  There was no material before this Panel by way of evidence of any relevant continuing professional development relating in particular to confidentiality and information governance, evidence of keeping up to date with her clinical skills, a Personal Development Plan or testimonial evidence from paid or unpaid employment.  In those circumstances the Panel concluded that the Registrant had not discharged the persuasive burden upon her and that her fitness to practise remains impaired.

40. In relation to the public interest component, this Panel agreed with the observations of previous Panels about the seriousness of the breaches of confidentiality in this case. Many of the documents wrongly stored at the Registrant’s home were mixed with other personal papers and the storage continued for a number of years. In the absence of any further engagement or evidence from the Registrant the Panel also found that the Registrant’s fitness to practise remains impaired on public interest grounds.

41. The Panel considered what, if any, sanction to impose and referred to the HCPTS Sanctions Policy. It noted that its powers included imposing a Striking Off Order since the Registrant has been continually suspended in excess of two years. 

42. The Panel was mindful that sanctions are not intended to punish registrants, but instead to ensure the public is protected. The Panel must strike a balance between the competing interests of the Registrant and the HCPC’s overriding objective to protect the public in arriving at a decision that is proportionate.  The Panel bore in mind it should consider the least restrictive sanction available to it first and only move to a more restrictive sanction if it considered it necessary to do so. 

43. The Panel considered that the potential sanctions of taking no further action, or imposing mediation or a caution order were not appropriate due to the serious nature of the findings.

44. In considering whether to impose a Conditions of Practice Order the Panel’s view was that this would not be appropriate or workable. The Registrant has not implemented any of the recommendations of the December 2020 or December 2021 review hearings and has evinced no intention to engage further in the regulatory process. In those circumstances a Conditions of Practice Order was not workable.

45. In considering whether to extend the current Suspension Order, the Panel considered that such order would protect the public from any immediate risk of harm; however, the Panel also took account of the Registrant’s persistent non-engagement and failure to act upon any of the recommendations of previous reviewing Panels or to provide any further evidence of remediation. The Panel was aware of the likelihood that the Registrant has become increasingly and significantly de-skilled and out of touch with developments in practice with the passage of time. Further, the Panel had regard to the email correspondence dated 5 September 2022 in which the Registrant indicated that she has “retired” and has no wish or intention to return to practice.   

46. In those circumstances, the Panel considered it was unlikely that an extension of the already lengthy period of suspension would result in the Registrant availing herself of any further opportunity to remediate her practice. Conversely a further Suspension Order would likely compound the process of de-skilling the Registrant, rendering her more out of touch with the standards of practice required and expected of her.   Further, to permit ongoing suspension with no correlating engagement from the Registrant to address identified deficiencies in practice may harm the public’s confidence in the regulatory process. 

47. Having regard to the Sanctions Policy, the Panel was aware that a Striking Off Order is the sanction of last resort and has a significant impact upon the Registrant. However, in the present circumstances the Panel determined that it was the only order that is sufficient both to protect the public and maintain public confidence in the regulatory process.   On this basis the Panel determined that, from the date of expiry of the existing Suspension Order, a Striking Off Order is the appropriate and proportionate sanction in this case.

ORDER: The Registrar is directed to strike the name of Helen Stokes from the HCPC register on expiry of the current order.

No notes available

History of Hearings for Helen J Stokes