Melanie Parton

Preliminary Matters

1.The Panel was convened to undertake the substantive hearing of the HCPC’s allegation against the Registrant, Mrs Melanie Parton, who is registered in the Chiropodists/Podiatrists part of the HCPC Register.

2. Before the Presenting Officer opened the case, the Panel considered a number of preliminary matters. They were:
· The nature of the allegation that had been referred by the Investigating Committee for hearing.
· Whether it would be appropriate for parts of the hearing to be conducted in private.
· Whether the HCPC should be permitted to rely on the statement of the witness identified as “Patient 1” as hearsay evidence without calling that witness to give evidence before the Panel.
· Reservations expressed by the Registrant about encountering two of the witnesses whom the HCPC intended to call as witnesses.

The nature of the allegation referred by the Investigating Committee.

3. The allegation referred for hearing by the Investigating Committee is a “dual allegation” as it includes contentions that the Registrant’s fitness to practise is impaired both by reason of misconduct and her health. However, the referral was directed for hearing to the Conduct and Competence Committee, and accordingly, the misconduct allegation is the primary allegation to be decided by the Panel. It will be necessary for the Panel to return to the issue of the secondary, health allegation once it has concluded its decisions on the primary, misconduct allegation.

Parts of the hearing to be conducted in private.

4. Quite apart from the fact that, as just described, an element of the allegation is concerned with the Registrant’s health, it was apparent to the Panel that the Registrant wished to introduce information concerning her health in relation to the misconduct allegation. Accordingly, the Panel directed that any mention of the Registrant’s health should be treated as having been given in private in order to protect her private life.

Patient 1’s witness statement being relied upon as hearsay evidence.

5. Particular 1(a) alleges that on 25 July 2018 the Registrant nipped Patient 1’s foot and/or burnt it with a sanding disc. When the case was listed for hearing in December 2022, the HCPC did not have a witness statement made by Patient 1 for the purposes of this fitness to practise process; as with other complaints it intended to rely on near-contemporary complaints made to Shuropody. However, between the adjournment of that hearing and the commencement of the present hearing, the HCPC sought and obtained a witness statement from Patient 1. It is dated 24 January 2023. The penultimate paragraph of the statement reads, “I am willing to attend a hearing in this matter to give evidence.” However, by the commencement of this hearing on 13 February 2023, a period of less than three weeks after the making of the statement, Patient 1 had changed her mind about her willingness to participate in the hearing and stated that she would not. This change in attitude resulted in the HCPC applying to be permitted to rely on the witness statement (along with the other information provided by Patient 1) being accepted as hearsay evidence by the Panel.

6. The Panel accepted the advice it received in relation to the admission of hearsay evidence; it would not be sufficient for the Panel merely to acknowledge that it could accord such weight as would be appropriate given its hearsay nature. To be admitted in the first place, the Panel should be satisfied that it would be fair to do so. Having carefully considered the matter, the Panel concluded that the admission of the evidence was consistent with the proceedings being fair, particularly to the Registrant. The statement dated 24 January 2023 was made specifically for these purposes and the Panel considered it appropriate to receive the statement in order to be able to assess the other relevant aspects of the evidence. Having acknowledged that the evidence should not be admitted merely because the weight properly to be attached to it at a later stage could be assessed, nevertheless, that assessment will, of course, be made in due course.

The Registrant’s reservations concerning two of the HCPC’s witnesses.

7. The Registrant informed the Panel that she would not be able to face, even in the context of a remote hearing conducted by video, the witnesses Mr MB and Mrs AN whose evidence was relevant to the particular 2 complaints. The Registrant was informed that the Panel wished her to engage to the fullest extent. The Registrant was informed that it would not be possible for the Legal Assessor to act as her advocate in the manner in which a representative would be expected to argue their client’s case, but she was told that if she felt she could not face the two witnesses but recorded in writing the points she would wish to be put to them, the Legal Assessor would endeavour to ask the questions she would have asked if she had been present. The extent to which this happened will be further explained below.

Amendment of the wording of allegation 2(b)

8. At the resumption of the hearing on 15 March 2023, during a Panel only decision day, the Panel gave careful consideration to the wording of particular 2(b), which included reference to ‘clinical staff’ as opposed to ‘clinic staff’. In the Panel’s view this wording could be construed to restrict the matters alleged to only those incidents that actually involved clinically qualified colleagues. This did not reflect the body of evidence provided to support this limb of the particular, which related in the main to interactions with a wider field of colleagues. This being the case, the Panel informed the parties that before handing down a decision on its findings of fact, it was inviting them to make their representations on the Panel’s proposal for amendment. The amendment was to delete the ‘al’ at the end of ‘clinical’. The Legal Advisor repeated in open session the advice she had given in private to the Panel which included reference to the HCPC cases of Ireland and Ma v HCPC [2015] EWHC 846 (Admin), PSA v HCPC and Doree [2017] EWCA Civ 319 which supported a panel in making an amendment to an allegation despite there being no statutory provision for such an amendment. The parties then made their representations on this proposal which were:

· The HCPC stated that when presenting the case it had been on the basis that clinical encapsulated the wider clinical setting within the Registrant was working and if this had not been absolutely clear then it is appropriate that this amendment is made.

· The Registrant did not raise any objection and agreed that clinic would include those such as receptionist.

9. After hearing those representations, the Panel concluded that it would so amend the wording of allegation 2(b) to refer to ‘clinic staff’ as:
· It was in the public interest to do.
· It added clarity to what was alleged.
· It better reflected the evidence.
· It did not cause the Registrant any prejudice as she had been on notice of the nature and the extent of the allegation since the bundle was first sent to the Registrant by post on 29 June 2021. The most recent version of the bundle was sent to the Registrant by post on 27 January 2023 and it was delivered and signed for by the Registrant on 28 January 2023.

Background

10. The HCPC’s case against the Registrant concerns alleged misconduct at two, unrelated workplaces. The first in time was the work reflected in particular 2. Between 3 March 2017 and 17 October 2017, the Registrant was employed as a Band 6 Podiatrist by the Staffordshire and Stoke-on-Trent Partnership NHS Trust (hereafter “the Trust”). The work involved travelling to different clinics within the geographical area covered by the Trust. In 2014 the Registrant had undertaken a student placement at the Trust, and during this period had had contact with Mr MB as he was then the Student Placement Supervisor. When the Registrant commenced her employment at the Trust in March 2017, Mr MB was himself a Band 6 Podiatrist. In July 2017 he became a Band 7 Podiatrist and Team Lead, and in that role became the Registrant’s line manager. Mrs AN was another Band 6 Podiatrist employed by the Trust. After some concerns were raised about the manner of the Registrant’s performance, Mr MB requested Mrs AN, a student placement coordinator, to provide some supervision sessions with the Registrant. The conclusion of the Registrant’s employment with the Trust arose because it was not continued after the probationary period.

11. Some while after the Registrant’s employment with the Trust came to an end, she undertook some work on a locum basis for a company named Shuropody. The dates between which this work was undertaken were 5 June 2018 and 27 July 2018, and it was undertaken at the Birmingham and Hanley branches of the organisation. It is alleged that, on the four dates identified in the sub-particulars of particular 1, the Registrant’s treatment of patients did not reach the required standard. Ms SK, the Head of Podiatry for Shuropody, gave evidence before the Panel. Ms SK had no personal knowledge of the Registrant and no direct knowledge of any of the complaints made by the HCPC relating to the Registrant’s time working as a locum for that organisation; Ms SK’s involvement arose because the complaints by service users came to her attention in her capacity as Head of Podiatry. As the Registrant’s work with Shuropody was undertaken on a locum basis, no formal dismissal took place; she was simply not asked to work further sessions for that organisation.

Decision on Facts

12. The Panel accepted the advice of the Legal Assessor as to the correct approach to the decision it was required to make in relation to the factual elements of the case. Two elements of that advice in particular should be referred to. First, that it was for the HCPC to discharge the burden of proof on the balance of probabilities; at no stage should the Registrant be expected to disprove anything alleged against her. Secondly, a great deal of the evidence relating to the complaints made against the Registrant was hearsay in nature, and that evidence needed to be treated with caution because it was not capable of being effectively challenged by the Registrant (or explored by the Panel) in the manner in which direct evidence could be probed.

13. The HCPC called the three witnesses whose roles have already been described to give evidence before the Panel:
· Ms SK in relation to the Shuropody complaints encapsulated in particular 1;
· Both Mr MB and Mrs AN in relation to the particular 2 complaints arising from the employment at the Trust.
· In addition to the oral evidence of these three witnesses, the Panel was provided with witness statements made by each of them, the witness statement dated 24 January 2023 made by Patient 1 to which reference has already been made and also an exhibits bundle extending to approximately 268 pages.

14. Mention should be made at this stage of the matter referred to in paragraph 7 above, where it was explained that the Registrant stated that she felt unable to deal directly with the evidence of Mr MB and Mrs AN. As suggested, the Registrant put in writing a number of issues she wished these witnesses to deal with and submitted them to the Hearings Officer, who in turn submitted them to the Legal Assessor. Mrs AN was called before Mr MB. When the time came for cross-examination of Mrs AN, the Registrant stated that she did indeed wish to ask some questions, which she did without either seeing or being seen by the witness. The Legal Assessor then asked some further questions informed by the issues the Registrant had put in writing. When Mr MB gave evidence, the Registrant stated that she wished to follow the same approach she had taken to Mrs AN. However, in the event, the questions she asked (again, without seeing or being seen by Mr MB) encapsulated all of the issues that had been put in writing. When the Legal Assessor said to the Registrant that it seemed to him that there was nothing further for him to deal with, the Registrant did not demur.

15. The Registrant herself gave evidence before the Panel and was cross-examined by the Presenting Officer. The Registrant also introduced documents upon which she wished to rely in her defence. The Registrant had maintained that her alleged health conditions had been a contributory factor in these matters. She had also maintained that three of the four incidents in particular 1 had taken place in the Birmingham clinic where the conditions were cramped and not conducive to safe practice.

16. The written submissions of the parties on the facts were prepared sequentially and were made available for the Panel before it embarked on its decision-making on the factual issues in the case on Wednesday 15 March 2023.

Particular 1

Whilst employed by Shuropody Foot Clinic between 05 June 2018 and 27 July 2018 you:

17. There was no dispute as to the dates and the nature of the complaints raised in this period. Three of the four incidents listed within this particular occurred at the Birmingham Clinics of Shuropody and the fourth at its Hanley branch. The Panel noted the Registrant’s view that the working conditions at Birmingham were cramped.

18. In support of this allegation the Panel had been provided with the statement of RK, who had not been personally involved in handling the complaints. RK was exhibiting the supporting evidence on behalf of the employing organisation. The Panel did not hear from the individuals who had responded to the complaints and/or from the person who had assembled the evidence, nor from the four patients who had raised complaints. The Panel had before it documentation that had been cut and pasted for exhibiting and so did not disclose the identities and/or dates of those complaints. The evidence included two sets of clinical notes and through careful analysis of the complaints the Panel was able to identify which of the four complainants these two sets of clinical notes related to.

19. The Panel noted that it was relying on a series of actions undertaken by those not giving testimony for the link to the evidence. The information was accepted to be hearsay, and so was admissible, however, as directed by the first Legal Assessor, such hearsay evidence should be treated with caution as it was not capable of being tested and probed. For these reasons the Panel has strenuously tested the information before it relating to all four complaints.

20. The Panel appreciates that it is not for the Registrant to disprove anything. In this regard the Panel noted that at the time of the complaints Shuropody had ceased to use the Registrant’s services without raising any questions or concerns directly with her, or taking the opportunity to discuss the individual complaints. This put the Registrant at some disadvantage in being able to recall, at a distance in time, or with reference to the clinical notes, those events. This was evident from her testimony. However, on some issues, the Registrant had a clear and consistent recall due to the unusual nature of the incidents.

Particular 1(a) On or about 25 July 2018 whilst treating Patient 1 you nipped Patient 1’s foot and burnt it with a sanding disc;

21. The evidence relied on by the HCPC was the statement of RK, her oral evidence and the exhibited documentation. There were supporting photographs taken by Patient 1 after her treatment session. As noted above, the witness statement of Patient 1 had been prepared relatively recently and so this patient’s recollection, as recorded within that statement, had been made at some distance from the events.

22. The Panel noted from her complaint that Patient 1 had been a patient of the Birmingham Clinic for over 20 years. She said that she had attended to have some hard skin removed and that the Registrant ‘had nipped her foot and burnt it with the file’. During the treatment she had, in her terms, ‘squirmed’. She stated that following the treatment the Registrant had told her ‘to keep an eye on that’. Patient 1 stated that following treatment, she had difficulty walking and had subsequently sought treatment from her GP for an infection.

23. The complaint from Patient 1 had been dealt with by someone within Shuropody who was not a witness at this hearing. That person stated in her response to Patient 1 that she had reviewed the clinical notes. However, the Panel having examined the notes alleged to relate to Patient 1, is not satisfied that these are consistent with the response to the complaint sent by Shuropody. AP (Regional Podiatry Clinical Manager) stated that she “had reviewed the written record of the appointment and it was noted that your heel looked pink and tender after callus reduction and an appropriate dressing was applied…” The notes provided for Patient 1 do not correspond with this description and do not mention any pink and tender areas. As such, the Panel could not rely on these notes.

24. Two photographs taken by Patient 1 were within the exhibited evidence. It was unclear whether the photographs had one or both been at the same time of treatment, or one at the time of treatment and then the other at a later date after Patient 1 had been walking on the affected/infected foot. Neither photograph showed a ‘nip’ to the skin, and when questioned, both RK and the Registrant were uncertain as to what was shown within one of the photographs. The Panel considers that the two photos may show an abrasion or friction burn to the heel but are not certain of this.

25. In her complaint Patient 1 had referred to the use of a ‘file’. According to RK, a file would not have caused such an injury. However, the photographic evidence appears to be of a ‘burn’ from friction which could have been caused by any abrasive equipment.

26. The allegation states that the Registrant has ‘burnt it with a sanding disc’. However, in Patient’s 1 complaint, it is stated that it was “burnt with a file”. Whilst there is reference to use of a sanding disc in the patient notes presented to the Panel. The Panel could not rely on these notes for the reasons mentioned above.

27.  The Panel has noted that the Registrant has denied that this incident took place and has stated that this was a patient she had treated for an ingrowing toenail. She was able to identify details of this patient clearly.

28. There is, in the Panel’s view, in relation to the evidence provided by the HCPC, sufficient doubt about the accuracy and robustness of that evidence. For these reasons the Panel has concluded that the requisite level of proof has not been reached and the allegation is not proven.

Particular 1(b) On or about 26 July 2018 whilst treating Patient 2, you cut her toenails too short and/or cut the skin on her feet on one or more occasions;

29. The Panel had before it 13 photos taken by Patient 2. In addition, it had the clinical notes of this treatment session.

30. The photographic evidence of the Patient’s feet was challenged by the Registrant who stated that these were not the same set of feet in each photograph. The Panel considered this challenge carefully. A review of the photos showed that all had been taken against the same back drop of a blueish green towel. Some showed the toes and feet with and without dressing and some had been taken at a slightly different angle to focus on the areas of concern. In the Panel’s view the feet in the photo were the same in each.

31. The evidence of Patient 2 was that the nails had been cut down at the side and were not level. The allegation is that the toenails having been ‘cut too short’. It was not evident from the Photographs that the nails had been cut down too far down and so the Panel makes not finding on this element of the limb.

32. The photographic evidence shows that there are cuts and the blood-stained dressing which has been removed from a toe supports this. The clinical notes of this session support the incident and record the action taken by the Registrant.

33. The Panel has therefore concluded that this particular is not proven in relation to the cutting of the nails as being ‘too short’ but proven in relation to the ‘cutting of the skin’.
Particular 1(c). On or about 20 July 2018 whilst treating Patient 3, you caused her toe to bleed;

34. This incident occurred in the Hanley clinic, and there is no photographic evidence from Patient 3 to support the complaint. No notes have been presented to the Panel relating to the treatment of this patient. Patient 3’s complaint is very brief, she stated, “she was so rough she made my toe poor [sic] of blood just slapped a dressing on” and makes no further reference to the treatment she received.

35. The Registrant stated that she only remembered this patient as the Registrant had been accused by this patient of making racist comments during a Brexit discussion and she could not recall details of the actual treatment provided.

36. The Panel find this allegation not proven.

1(d) On or about 24 July 2018 whilst treating Patient 4, you cut her big toe.

37. This Patient noted in her complaint that she had received podiatry treatment for over twenty years and had never been cut and have blood dripping from her big toe. She records the Registrant responding saying that ‘there was a first time for everything’. Patient 4 records that the wound had been dressed and advice to go to the doctor for antibiotics if it started ‘to develop pus’. She had complained and put her concerns about the Registrant being ‘heavy handed with the scapel’ on record in case an infection did set in.

38. The Panel did not have any clinical notes, nor any photographic evidence to support this allegation.

39. The Registrant initially admitted this incident had happened but was later recorded as saying that she had ‘no idea’ about it.

40. The Panel find this particular not proven on the basis of it just not reaching the requisite threshold.

Allegation 2 Whilst employed by Staffordshire and Stoke-on-Trent Partnership NHS Trust between 03 March 2017 and 17 October 2017 you:

41. There was no challenge to the dates that the Registrant worked for the Trust. The Panel noted that whilst employed the Registrant had two periods of absence. The first was a period of five weeks during May 2017 when the Registrant had fallen whilst at work and broken her ankle. She was absent for a month with this complaint and then immediately took a further week off as annual leave. This was for a period of several weeks. These two periods of absence reduce the amount of working time from 7 to 5 months.

42. The Panel have seen documentary evidence at the initial probationary meeting on 14 February 2017, the Registrant was advised to use the work phone to make contact if late or unable to find an address. She was also advised that the hours of work would be 8:40am – 5:00pm (Monday-Thursday) and 8:40am – 4:35pm (Friday). The documentary evidence also records a three-month probationary review on 3 April 2017 which states “agreed that MPs time keeping had improved, but was still a working progress. MP continues to be slightly late, although this varied from day to day”. The Registrant is recorded as working at eight different locations during her time with the Trust. On some days morning and afternoon sessions were in different locations. There had also been two periods of supervision with AN during which the Registrant had seen only a limited number of patients.

Particular 2(a) Did not manage your timekeeping by frequently arriving late to the workplace.

43. The Panel had before it the evidence produced by MB in which he had recorded on a timeline the number of occasions that the Registrant had been reported as turning up late for work and/or clinic appointments. The Registrant had been recorded as being late on at least eight occasions.

44. The evidence from the two HCPC witnesses was supported by documentary evidence in the form of emails from reception staff and administrative colleagues in which they record those sessions and appointments had been delayed or missed due to the late arrival of the Registrant. This documentary evidence did not relate to every date identified in the timeline prepared by MB.

45. The number of occasions on which the Registrant is recorded as having arrived late could not all be put down to individual and isolated traffic catastrophes, such as the occasion when the Registrant had not been able to get out of her driveway and turn left due to an accident on the motorway. The evidence is indicative of an inability to plan and manage her time effectively, and this being the case, the Panel find this particular proven.

Particular 2(b) Demonstrated inappropriate and/or unprofessional behaviour in that you showed aggressive and/or confrontational behaviour to clinic(al) staff.

46. As recorded in the Preliminary matters section of this decision, the Panel has concluded that the evidence it has before is not adequately reflected in the wording of the particular and so had made an amendment with the deletion of ‘al’ from the end of clinical.

47. The Panel had before it evidence from a number of different sources that record the Registrant’s inappropriate behaviour. In relation to her interaction with them, comments recorded include (amongst others) ‘Wind your neck in’, ‘I don’t do socialising’, ‘Please leave my clinic’, and ‘Get out’. MB had told the Panel that he had in fact been shocked at the extent and nature of the displays of anger and shouting during a telephone call with the Registrant.

48. The Registrant has accepted that she shouts. She has also told the Panel that she has difficulty with her hearing however the Panel note that this is not an issue which is listed within Schedule A. In these proceedings the Registrant has spoken loudly and her demeanour has been confrontational.

49. The Panel therefore find this particular proven,

Particular 2(c) Were unable to practise autonomously, in that you required supervision and/or prompting and/or support from managers and colleagues.

50. The Panel had evidence from AN of three occasions when during periods of supervision the Registrant had not, in her view, undertaken appropriate action immediately.

· One was when the Registrant had required, in her view, prompting to remove more of a nail to disclose an underlying problem. As the intervention was made immediately by AN there was uncertainty as to whether the Registrant was in fact just about to undertake this action of cutting further down the nail herself, after having first cut the nail back to view better the area underneath.
· The other occasion recorded by AN was a failure to put a sharp into a disposal container completely, the Registrant having left a small portion sticking up out of the container. A shake of this container would have solved this issue. It was again not clear to the Panel whether the Registrant had been given time to note and address this failure, due to the prompt intervention.
· AN also observed a “sawing” technique when filing nails being performed by the Registrant which she denies.

51. The evidence before this Panel is that the Registrant had worked for a considerable amount of time on her own without any previous cause for concern about her ability to work autonomously. In the Panel’s view there is insufficient evidence placed before it by the HCPC to make a finding that the Registrant is unable to practice autonomously. The Panel therefore find this particular not proven.

Particular 3

52. In relation to particular 3, relating to the medical conditions listed in schedule A, the Panel noted the documentary evidence provided by the Registrant. These had been voluntarily provided during the course of the further investigation undertaken by Kingsley Napley on behalf of the HCPC. The vast majority of this medical information related to assessments undertaken after the periods referred to within the Allegation.

Grounds

Submissions

53. The HCPC in its submission on the issue of misconduct stressed that these matters, relating to unprofessional conduct, would, in the HCPC’s view, amount to serious professional misconduct.

54. Allegation 1(b) amounts to misconduct as it reflects a fundamental failure by the Registrant to ensure that her patient was not exposed to unacceptable risk when she was being treated. In layperson’s terms, patients should not be injured to the extent that Patient 2 was during her treatment. It was the Registrant’s responsibility to position and immobilise Patient 2 correctly in order to carry out a safe and effective intervention. The treatment provided to Patient 2 fell short of what was proper in the circumstances, and the Registrant’s acts in relation to Patient 2 are serious enough to amount to misconduct.

55. Allegation 2(a) reflects a serious failure on the part of the Registrant to carry out her job properly. The Standard of Proficiency for Chiropodists/Podiatrists numbered 3, requires that registrants are able to maintain fitness to practise by understanding the need to maintain high standards of personal and professional conduct. Poor timekeeping, on the scale of this case, which continued despite repeated warnings and attempts to provide support, such that it is “indicative of an inability to plan and manage” time effectively as found by the Panel, amounts to a serious falling short of the standards expected of a podiatrist.

56. Allegation 2(b) reflects inappropriate behaviour against a number of different colleagues, involving the Registrant shouting and making comments such as “wind your neck in”. The Panel has already noted MB’s evidence, where he recalled being “shocked” at the extent and nature of the Registrant’s anger and shouting during a telephone call he had with her. That sort of behaviour is unacceptable in a professional context.

57. The HCPC directed the Panel to the terms of the Standards of Conduct Performance and Ethics and submitted that the following sections that had been breached were 2.5 and 6.2, relating to working collaboratively with colleagues and not putting service user’s health at risk.

58. The HCPC also considered that sections of the Standards of Proficiency for Chiropodists/Podiatrists were relevant to the matters found proven and directed the Panel to sections 3.1, 9.1, 9.2, 15.1 and 15.6.

59. The Registrant stated that basically everything and anything that has gone on within that the Health Trust was difficult. It was difficult to maintain relationships with people when they were bullying you each day. The Registrant maintained that there was nothing wrong with her practice prior to being subjected to bullying. At Stoke, on a daily basis, she was subjected to inappropriate behaviour, for instance when she had a broken foot, no one offered her help. She was, she believed, treated badly. When a practitioner is subjected to that level of daily stress it would put service users at risk.

60. The Registrant accepted that she was clearly in distress during the telephone call with MB. The Registrant admits that she is loud normally, but what she believed she was subjected to, by him, in that telephone call, would have provoked anyone. MB was standing up for ‘his mate’ within the organisation, a person who was subsequently found to be lying. The Registrant stated that at times she endured physical abuse, such as shoulder barging, which is an assault. The Registrant emphasised that she suffered for ten months during which time ‘they all ganged up’ on her, this included reception staff as well as fellow clinicians and management. The Registrant took advice from ACAS to write a letter relating to this alleged bullying at Stoke. The Registrant considered that she did better than she believed herself capable of in the circumstances. Things said to her face and things recorded on the web since she left that organisation support her contention of bullying. The Registrant stated that she had not encountered this level of confrontation at previous organisations, and it was only at Stoke and Shuropody that she had been bullied. Never experienced it elsewhere before or since. The Registrant directed the Panel to her bundle of documentation in which she claimed that it is recorded that she is motivational and professional. She has received a wealth of good feedback.

61. The Registrant accepted it was her responsibility to manage the risk to service users when working in very difficult circumstances and environment. However, audits were not carried out as management said they would be at Shuropody. The Registrant recorded that due to not having the appropriate blades and equipment she cut herself more than she previously had. She stated that is not unusual for a practitioner to cut a patient, but poor equipment did not assist in this.

62. The Registrant stated that timekeeping is not an issue for the HCPC to consider, it is a managerial issue. The employing organisation Stoke, had not, in her view, taken into account where she lived. She had applied for a job in the Fenton branch, and then after three weeks in that location she had been sent to work in Leek, a clinic that no other clinician else wanted to go to work.

Legal Advice

63. The Legal Assessor gave her advice which included the guidance set out in the case of Roylance v GMC (No 2) [2000] 1 A.C. 311 at 331 as:
“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the conduct to the profession of medicine. Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious …”

64. Whilst the Panel should consider the findings individually and collectively it should assess them first individually to see the threshold for misconduct has been reached and whether it amounted to serious misconduct or, as identified in the case of Nandi v GMC [2004] EWHC 2317 (Admin), amounted to conduct which a fellow practitioner would consider to be ‘deplorable’.

65. The Panel should also consider, as stated in the case of Shaw v General Osteopathic Council [2015] EWHC 2721 that misconduct or unacceptable professional conduct must contain elements of moral blameworthiness.

66. The Panel should also be aware that as set out in the case of Scholock v GMC [2015] EWCA Civ 769 discouraged Panels from cumulating a number of non-serious misconduct allegations in order to come toa finding of serious professional misconduct. That case has also indicated that it would be a very unusual case on very unusual facts in which this could be lawful.

Panel decision

67. The Panel is aware that at this point in the process there is no burden on the HCPC and that the Panel may take into account all information before it. It appreciated that it is a matter for its professional judgement as to whether the conduct found proven meets the requisite threshold.

68. The Panel appreciated that a breach of the Standards of Conduct Performance and Ethics does not, of itself, automatically equate to a finding of misconduct. Whilst the HCPC has directed the Panel to certain sections the Panel was aware that it was at liberty to consider all or any of the standards. The Panel has concluded that the matters on which it has made a finding, namely 1(b) in part, 2(a) and 2(b) would be in breach of the following standards:

2.1 You must be polite and considerate.
2.5 You must work in partnership with colleagues, sharing your skills, knowledge and experience where appropriate, for the benefit of service users and carers.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
6.1 You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.
6.2 You must not do anything, or allow someone else to do anything, which could put the health or safety of a service user, carer or colleague at unacceptable risk.
9.1 You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.
69. The Panel has also considered the Standards of Proficiency for chiropodists/podiatrists, and concluded that there has been breach of the following:

3.1 understand the need to maintain high standards of personal and professional conduct.
4.6 understand the importance of participating in training supervision and mentoring.
8.1 Be able to demonstrate effective and appropriate verbal and non-verbal skills in communicating information, advise instruction and professional opinion to service users, colleagues and others.
8.4 be able to select, move between and use appropriate forms of verbal and non verbal communication with service users and others.
9.1 be able to work, where appropriate, in partnership with service users, other professionals, support staff and others.
9.2 understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team.
9.4 able to contribute effectively to work undertaken as part of a Multi-disciplinary Team.
11.1 understand the value of reflection on practice and the need to record the outcome of such reflection.
15.1 understand the need to maintain the safety of both service users and those involved in their care.
15.6 know how to position or immobilise patients correctly for safe and effective interventions.

70. In relation to 1(b), the Panel noted the Registrant’s reason for making some cutting errors. She blamed this on the cramped surroundings in which she had to work in the Birmingham clinic of Shuropody. She considered that this had adversely affected her performance. The evidence before this Panel is that other practitioners had not attracted complaints for making cuts to patients' feet. The evidence from witness RK, was that the normal number of complaints, was approximately one a month across the 46 stores. However, in the instance of the Registrant, there had been four complaints within a 7-day period, which was excessively more in terms of frequency and number. The Panel considered that if a working situation was unsafe, it was a matter that she should have followed up at a higher level if the management did nothing to address this. It was in the Registrant’s interests and those of her service users’ to escalate this concern in line with 7.1, 7.4 and 7.5 of Standard Conduct Ethics and Performance and to refrain from working in that environment.

71. The Panel heard evidence that the number of complaints that the Registrant had cut patients, were considered disproportionate during this period when she was seeking medical assessment.

72. Whilst the Panel is aware that it has made finding on this one incident, it has taken into account the totality of the information placed before it in assessing the risk factors the Registrant would have been aware of and was exposing her patients to. In the Panel’s view, the Registrant would have been aware of her limitations in her abilities from her consultation with the Consultant Surgeon. She was also aware of the difficult conditions she was working in with her physical abilities being affected. The Registrant nevertheless treated patients within an environment she considered to be challenging. The Registrant told the Panel on several occasions that she continued because “she needed the money”. The Panel considers that her actions in continuing to practise and to put this patient, and indeed all of her patients, at risk amounts to serious misconduct. Whilst the Registrant admitted “it's me that cut them” in reference to the four patients who complained to Shuropody within one week, the Panel were only sufficiently satisfied in respect of the evidence to find Charge 1b proven.

73. In relation to 2(a), the Panel considered that the Registrant’s actions of consistently arriving late, and so putting colleagues and service users to inconvenience was unprofessional. It was also inconsiderate and avoidable. The Registrant is entitled to her lunch and to take it at an appropriate point in the day, however, if this would result in her delay in attending another clinic, then she should have taken the guidance she had been given by her employers relating to communicating this delay in advance. The Registrant described ‘time blindness’ as a characteristic of her condition but gave no evidence of its application to her.

74. The Panel having made these observations, noted that there was no evidence from any source that lateness was an issue in other environments in which the Registrant had worked. The Panel also noted that the Registrant had stated times and distances for travel which were not consistent with the geography of the locations given as her start and finish points. This attitudinal and behavioural approach was demonstrated by an occasion when there was a traffic collision on the normal route to the Registrant’s workplace. The Registrant notified her work colleagues that she would be unable to get to work that day, without attempting any alternative routes. The Panel took into account that over a ten-month period, there had been consistent lateness, lack of communication of that lateness and co-operation with management on this issue. The impact of this behaviour on the service, her colleagues and patients was considerable. There is no indication that the Registrant made any efforts to address these issues or accept advice as to how to avoid, for instance, poor communications. The Panel, therefore, considered that there was a pattern of behaviour which supports a finding of serious misconduct.

75. In relation to 2(b), the Registrant’s communication with colleagues, the number and variety of reports of using insulting, unprofessional, and inappropriate and aggressive behaviour and language was, in the Panel’s view, excessive. This behaviour could not be considered a one-off temper tantrum, but a pattern of angry, loud and abusive communication.

76. The Registrant has stated that she is naturally loud and this was in part due to her poor hearing. The Panel noted that although identified at birth as having some hearing issues there is no medical supporting documentation. The Panel has also noted that the Registrant has not encountered any difficulties in hearing the Panel or witnesses during this regulatory hearing.

77. The Panel considers that there is a pattern of unprofessional behaviour which is totally unacceptable and does breach the threshold of serious misconduct.

78. The Panel is therefore of the view that the matters found proven individually and also collectively amount to serious misconduct.

Impairment

Preliminary matters at resumption of hearing on 2 May 2023

79. The Panel acknowledged that the last two sentences of 89 could be open to misinterpretation. The Panel reaffirmed and were abundantly clear that it has not taken into account any matters which it has not made a finding upon.

80. The lack of clarity was addressed by the Panel making a slight amendment to the wording in that paragraph to make it absolutely clear the basis for their determination. The Panel accepted the advice of the Legal Assessor in relation to this.

81. The sentence ‘Whilst the Panel acknowledged occasional haemorrhages to skin are a risk as part of the normal podiatry practise, the frequency of haemorrhages caused by the Registrant in one week exceeds the normal tolerance.’ was deleted from the decision as this potentially led to a the lack of clarity outlined above.

HCPC submissions

82. The HCPC submitted that in relation to the personal component of the Panel’s decision it should note that the HCPTS Practice Note states that denying the facts does not stop a registrant from demonstrating insight at the impairment stage.

83. The HCPC further submitted that a registrant who takes insufficient or inadequate positive steps to acknowledge and address deficiencies in their practise or behaviour may pose a significant risk of repetition. In this case, the Panel may find that although the Registrant has taken some steps to remediate her actions (shown by the CPD she had evidenced), the lack of an apology and the denial of the facts (in this case) are indicative of very limited insight.

84. It was submitted that the Panel may feel from having listened to the Registrant’s evidence that she has a tendency to blame others for the outcomes in all of the allegations found proven.

85. The HCPC submitted that in Allegation 1b for example, the Panel will recall the Registrant blaming (among other things), the facilities, the patient jerking her foot and her manager’s behaviour for setting the conditions which led to her cutting Patient 2.

86. The HCPC drew the attention of the Panel to Allegations 2a and 2b. It was submitted that the Panel have heard extensive evidence from the Registrant in relation to her treatment at the hands of her colleagues, and how this impacted on her responses to them. The HCPC submitted that the Panel may feel that rather than accept responsibility for her own shortcomings, the Registrant has consistently sought to attach blame to others.

87. The HCPC put forward that the Panel at paragraph 49 of the judgment describe the Registrant’s demeanour in these proceedings as being ‘confrontational’.

88. It was submitted that in relation to the public component, the lack of professionalism demonstrated in this case is such that the public would expect a marker to be laid down. Cutting a patient’s foot more than once in a single treatment is not something that members of the public expect from podiatrists – the tone of anger and surprise in Patient 2’s complaint email gives an indication of what the public’s perception would be of that incident. The same is true for the failings identified in Allegation 2a and b: public confidence in the profession of podiatry would be shaken if the professional failings were not marked in some way. If a finding of impairment were not made in this case, public trust in the profession and the upholding of proper professional standards would be undermined.
Registrant’s submissions given under oath at her request including responses to questions from the Panel at this stage

89. The Registrant confirmed that she had not worked outside of Podiatry for four years, and so like riding a bike, she is out of practice. The way to deal with this is to return to podiatry but she cannot do so until she has addressed all the issues which had affected her, as a result of the bullying she suffered at Stoke and Shuropody.

90. The Registrant described her behaviour as reactive, reactive to other people’s bullying behaviour. In other environments she is charming and totally different. This Panel has only heard the other side of her from those who had been bullying her. She recounted that having five bullying women focusing their comments and behaviour at you was so painful. The Registrant took the opportunity to restate her views on what happened at the Trust and how it affected her to the degree of affecting her health and her will to live.

91. The Registrant stated that she worked at Sandwell as a Band 5 Podiatrist for 15 months and did not experience any problems.

92. The Registrant stated that she had retrained to be a teacher of podiatry and she would not be expecting to undertake work on patient’s full time. Part-time teaching and part-time working is her objective. She has had fantastic support from Telford University and now has a workable plan of action for her educational job.

93. The Registrant stated that in relation to ensuring public safety she has undertaken a lot of CPD and has sought advice from the HCPC on what further training she could undertake to address the issues identified. The only course she could find was expensive and it was unclear to her if it would be appropriate. The Registrant was of the view that she could not decide if the course would be worthwhile until the outcome of these proceedings was known.

94. The Registrant stated that despite Occupational Health being on her side, and confirming she had disclosed her issues with her wrist, Shuropody denied that the Registrant had so disclosed. The Registrant stated that it was regrettable that the cutting happened but to cut one person in very difficult circumstances is not unexpected. She stated that she has cut one person in a long career which included thousands of patients.

95. The Registrant stated that in relation to her personal health and mental wellbeing the Registrant confirmed that she is going back again into therapy in mid-May. This course of therapy is to provide her with a full understanding and identify what she can do to deal with bullying, a series of coping strategies.

96. The Registrant stated that it was wrong for the HCPC to apply the ‘Medical model’ when it should have been applying ‘the social model’. She submitted that use of the medical model has been banned for years and she maintained that her employers should have put equitable measures into place.

97. The Registrant had told the Panel that she had been offered a job, but due to her potential new employers being unwilling to give her time to attend this hearing, which was scheduled for this week, she was unable to take up that post. She has been unemployed since October 2022. The Registrant stated that she has privately paid over £11k for her recent Masters degree.

98. The Registrant asserted that no training was given by the NHS. She was denied support for studying other aspects of practice which were not directly relevant for the work she was employed to do. The Registrant stated that there was no path for advancement within the NHS. The Registrant expressed more widely her concerns about the NHS.

99. The Registrant explained that she is cautious about what she does and when. For instance, she would not undertake heavy DIY the day before work. However, she explained that she has been able to undertake DIY with her husband. She has undertaken some tough DIY (fitting of an entire kitchen, built an outdoor bar, and tiling). The Registrant stated that she would be mindful when using things which cause reverberation, such as a drill which causes her wrist to “ache”.

100. The Registrant accepted that she may need some aid for her to undertake podiatry, as her fine motor skills with a scalpel have not been tested. The Registrant is currently not aware of what exists that would be of assistance to her, something like a fatter handle, for example, may be useful.

101. PRIVATE.

102. The Registrant was asked how she would ensure communication with colleagues was effective. The Registrant responded saying she would check understanding by asking colleagues to repeat what she had said.

103. The Registrant was asked how she would cope with authoritative and overbearing women, given the evidence that she had previously provided on this point. She responded saying that she would find a buddy system and that she would try to communicate directly with the manager. PRIVATE.

104. The Registrant stated that she felt professional and she was able to work in a previous role successfully. At Sandwell, for instance, she was the guinea pig and in one instance a band 7 and on a band 8, had not undertaken the tasks correctly but she knew how to.

105. The Registrant stated that there is another side to her which these proceedings had not shown. A person who, when in control, can function but there is also a person who cannot work when not in control of things.

106. The Registrant stated that the HCPC is putting people out of work with this process, people who could work with sensible adaptions and facilities. The HCPC should show those who are their paying registrants more support. She did not feel supported by the HCPC. PRIVATE.

Panel Decision

107. The Panel accepted the detailed legal advice of the Legal Assessor, which emphasised that this this was a two-stage process of first assessing the current personal abilities of the Registrant in relation to her fitness to practice and then consideration of the public component of its decision. In relation to the personal components the Panel has to assess whether the misconduct found was remediable, had been remedied and there was no likelihood of a repetition of that behaviour in the future. In relation to the public component, the Panel should consider the impact of the Registrant’s behaviour on the confidence the public and fellow practitioners may have in the professional and regulatory process if no finding of impairment was made in the circumstances of this case. The Panel was reminded that its assessment was of the Registrant’s abilities and reflection on her behaviour as of today.

108. In determining whether there has been any remediation, the Panel noted the following:

· The Registrant had undertaken a considerable amount of study since these events. Those courses of study were not clinically focused and it was not evident that she had maintained her professional knowledge and understanding of practice in Podiatry up to date. The Panel accepted that there may be monetary restraints on her ability to undertake studying. Many CPD activities are inexpensive and accessible. The Panel noted that, to date, the Registrant has not provided evidence that she has engaged in clinically relevant ongoing learning. The Registrant has accepted that she is not able to return to practice yet, having been out of practice for four years.

· The Registrant’s acceptance of her limitations included her acknowledgement that a part time position alongside a part time teaching post would be the most workable solution given her health conditions. The Registrant stated that she wished to avoid stressful situations, however, just the starting of a period of employment will in itself be stressful. The Registrant’s ability to employ coping strategies for working in a pressurised new position have not yet been fully identified, developed or demonstrated.

· The Registrant has the right to not have an operation on her wrist, however she has to be able to demonstrate that in so doing she is not going to cause harm to patients. The Registrant believes that she can manage her wrist condition, but this has not been tested and it is unclear as to how this will be tested before resumption of work.

· In this regard, the Panel noted and was sympathetic to the Registrant still being at an early stage in understanding and accepting the difficulties she has encountered all of her life due to her neurodiversity. Her understanding of her conditions and how to adopt and adapt to them is still developing.

109. The Panel considered that in the best interests of patients the Registrant is not clinically fit to return to unrestricted practice at this time.

110. In terms of repetition in the future the Panel considered the level of insight the Registrant has gained into her previous behaviour. The Panel noted that the Registrant is still focusing on the impact of events on her, rather than her impact on a patient or her colleagues. She stated that she considered that they had provoked a reaction from her. The Registrant had not demonstrated during the whole course of this hearing an appreciation of the impact of her behaviour on others, including her patients and colleagues. The Panel were concerned at the Registrant’s lack of insight to the role her actions and behaviour played in the matters of serious misconduct found proven.

111. The Panel found that the Registrant expressed limited remorse for her conduct. The Registrant stated that it was regrettable that she had cut this patient. The Panel found that she was more focused on apportioning the blame elsewhere. The Registrant had not expressed shock at the extent of the cutting and her only description of the event initially was to express her irritation that the patient had taken their dressing off.

112. The level of insight expressed by the Registrant into her behaviour was, in the Panel’s view, concerningly absent. PRIVATE. These proceedings may also have provided an opportunity to identify issues on which the Registrant could have reflected and gained some insight into her previous behaviour. The Panel found that there was no evidence of a current change of attitude to the events. The Panel acknowledged that such reflection and insight could develop in the future.

113. The Panel therefore finds that on the personal component there is no evidence of remediation and a high level of likelihood that the behaviour would be repeated in the future. The Panel therefore finds current impairment of the Registrant’s fitness to practice on the personal component.

114. The Panel found that the Registrant’s lack of insight would be a matter of concern to patients and colleagues should they be in receipt of the full facts of this case. The public would be rightly concerned, that a practitioner who had displayed such reprehensible behaviour to patients and colleagues, was allowed to return to unrestricted practice. An ordinary and well-informed person who was aware of the findings of misconduct would be concerned if the Registrant was allowed to return to unrestricted practice. This would undermine the confidence of the public in the registrant, the profession and her regulator and the regulatory process. The Panel therefore finds current impairment of the Registrant’s fitness to practice on the public component.

Decision on Sanction

115. The HCPC indicated that the matter of sanction is one for the Panel. It was submitted that the HCPC do not ask for any particular sanction, but reminded the Panel that in this case all sanctions were open to it.

116. In terms of aggravating features, the HCPC put forward that there was no evidence of remediation, and that the Registrant had not shown any insight. It was also submitted that a Service user had been caused harm.

117. With regards to the mitigating features, the HCPC confirmed that the Registrant had no previous fitness to practice findings against her.

118. The Registrant expressed that she expected there to be some form of sanction. She felt that she had not been assisted in terms of what she should now do in order to become fit to practice as a podiatrist. She explained that she would actively seek and would value guidance from the Panel about steps she could take to demonstrate this.

119. The Panel accepted the advice of the Legal Assessor as to the approach it should take.

120. The Panel acknowledged that the decision as to the appropriate sanction, if any, to impose in this case is a matter for the panel exercising its own judgement. The Panel was aware that the main reason for imposing any sanction is to protect the public and that sanctions are not imposed to punish the Registrant.

121. The Panel had full regard to the HCPC Sanction’s policy. It had regard to the Equality Act 2010. The Panel also applied the principle of proportionality, in balancing the Registrant’s interests with those of the public.

122. The Panel found the following mitigating factors:

· There had been no previous regulatory findings against the Registrant.

· PRIVATE

· The Registrant acknowledged the need to complete CPD before returning to practice.

· The Registrant had engaged fully with the proceedings.

123. The Panel found the following aggravating factors:

· There was a lack of insight, remorse or meaningful apology.

· The Registrant had caused harm to one patient.

· There was a failure to work in partnership with colleagues.

124. The Panel determined that there were no exceptional circumstances to justify taking no action in this case. It considered that taking no action would not be appropriate, proportionate or in the public interest.

125. The Panel did not consider that this was a case where a Caution Order would sufficiently address the seriousness of the behaviour of the kind demonstrated by the Registrant.

126. The Panel next considered whether it would be appropriate to impose Conditions of Practice on the Registrant.

127. The Panel noted that the Registrant had not been in practice for 4 years. The Registrant had not kept her clinical skills up-to-date in this period and there was therefore a current risk of harm even with conditions of practice in place. The Panel took the view that it was not possible at this stage to formulate realistic, appropriate and suitable conditions. To attempt to do so could cause ‘suspension by the back door’ and would not be in the interests of either the public or the Registrant.

128. The Panel then moved on to consider whether a Suspension Order was appropriate. It had already determined that the issues in relation to the Registrant’s fitness to practice are potentially remediable. It took the view that a Suspension Order was a proportionate response to reflect the seriousness of the charges found proved.

129. Proportionality was considered by the Panel in relation to the length of any Suspension Order as well as the necessity for the order itself. The Panel determined that an Order of 12 months was the appropriate length. The Panel also considered that a 12-month Suspension Order was proportionate in reflecting the seriousness of the matters found proved and to meet the public interest. This would give the Registrant sufficient time to undertake clinical CPD and give her a realistic opportunity of achieving fitness to practice. The Panel was of the view that any shorter period would not give the Registrant sufficient time to address the concerns that had been raised.

130. The Panel did consider the sanction of Strike Off. It took the view that this was disproportionate to the misconduct found proven and was not currently necessary to protect the public.

131. The Registrant specifically requested guidance from the Panel as to activities and CPD she could undertake. She expressed some confusion as to the role of the HCPC in providing such guidance and disappointment at the lack of support provided thus far from sources she had approached. For the benefit of the Registrant, and not to be prescriptive or to bind the hands of the reviewing Panel, the Panel has provided the following list of potential activities which may assist her in the future:

· Independently construct a learning development plan, identifying the key areas for development and an action plan to start to implement.

· Source a suitable mentor currently practising in Podiatry who can guide and support all CPD activities and feedback on reflective work.

· Join one of the Podiatry professional bodies (Royal College of Podiatry, Institute of Chiropodists and Podiatrists, British Chiropody and Podiatry Association) and engage in conferences, online training, branch meetings and build networks within the professional communities.

· Engage in current Podiatry literature using journals critically reviewing its relevance to clinical podiatry – demonstrate the learning through reflective pieces indicating how this might impact on future practice.

· Shadow qualified Podiatrists to become re-acquainted with the clinical arena. 

· Explore and investigate different ergonomic solutions to ensure the manual dexterity and fine motor skills required to practice can be safely achieved.  For example, different scalpel handles could be tested using oranges or candle wax to practice debridement.

· Contact Podiatry schools to discuss the availability of possible modules relevant to return to practice.

132. The Panel acknowledges that providing the list above is unusual as Podiatrists are expected to autonomously identify and implement their ongoing learning and development needs. The Panel were mindful of the difficulties that the Registrant has described experiencing as a result of her medical conditions. The Panel therefore took the view that providing this guidance was a reasonable adjustment to make for this Registrant.

133. The Panel is clear that it does not intend to be overly prescriptive or to bind the hands of any future Panel as to whether the Registrant’s fitness to practice remains impaired when the matter is reviewed.

134. Having noted the Registrant’s specific request for guidance, the Panel would suggest that a reviewing panel may be assisted by the Registrant providing:

· A reflective piece setting out all the activities the Registrant has undertaken and how the Registrant has up-dated her clinical practice.

· A reflective piece setting out the Registrant’s understanding of the misconduct that has been found proved and expressing remorse.

· Verifiable, signed and dated testimonials and/or references including Podiatry relevant colleagues, tutors or supervisors. It would be particularly helpful if the author(s) of these testimonials can confirm that they are aware of the broad nature of the matters dealt with at this hearing.

· Documented evidence of training courses and/or CPD that the Registrant has undertaken since 3 May 2023, which relate to clinical podiatry practice and /or inter-personal skills.

135. Initially the HCPC applied for the outstanding secondary allegations to be referred to the Health Committee. However, once the decision had been fully considered, it was confirmed that the HCPC now applied to discontinue the secondary health allegations.

136. The Panel accepted the advice of the Legal Assessor. It had full regard to the HCPC Practice Note ‘Approach to dual allegations’ dated June 2021.

137. The Panel was in agreement with the representations made by the HCPC. It determined that the Sanction imposed was sufficient to protect the public. The Panel was of the view that it had addressed the risks posed by the Registrant fully within the decision outlined above. A further referral to the Health Committee was not in the interests of either the Registrant or the public. It was also not necessary to refer to the Health Committee in order to uphold public confidence in the regulator.

138. The Panel therefore reconvened as a Panel of the Health Committee and discontinued allegations 3. and 5 in part (By reason of your health your fitness to practice is impaired.)

ORDER: That the Registrar is directed to suspend the registration of Mrs Melanie Parton for a period of 12 months from the date this order comes into effect.

Interim Order

Decision

The Panel makes an Interim Suspension Order under Article 31(2) of the Health Professions Order 2001, the same being necessary to protect members of the public and being otherwise in the public interest.

This order will expire: (if no appeal is made against the Panel’s decision and Order) upon the expiry of the period during which such an appeal could be made; (if an appeal is made against the Panel’s decision and Order) the final determination of that appeal, subject to a maximum period of 18 months.

History of Hearings for Melanie Parton