Umalini Kathirgamanathan

Preliminary Matters
Service
1. The Panel was satisfied on the papers that the Registrant had been properly served with notice of today’s hearing by email dated 20 March 2025 in accordance with the Health and Care Professions (Conduct and Competence Committee) (Procedure) Rules 2003, as amended. Delivery of that notice was confirmed on the same date.
Proceeding in absence

2. Mr Bellis made an application for the hearing to proceed in the absence of the Registrant on the grounds that she had voluntarily absented herself and waived her right to attend.

3. The Panel had regard to the HCPTS Practice Note on “Proceeding in the Absence of the Registrant” and accepted the advice of the Legal Assessor. The Panel noted the email to the HCPC dated 8 April 2025 from the Registrant’s manager at Leeds and York Partnership NHS Foundation Trust, which stated that the Registrant had been off work sick since 24 June 2024 and that her sickness leave is currently extended until 22 April 2025. The Registrant contacted the HCPC in response to the notice of hearing on 16 April 2025 indicating that she would not be attend due to her health. The Panel therefore inferred that she had voluntarily absented herself and waived her right to attend. Today’s hearing is a mandatory review and must be heard before its expiry on 13 May 2025. The Panel had no reason to think that the Registrant would attend if the hearing were adjourned to a later date or that any useful purpose would be served by an adjournment. The Panel therefore decided that it was in the public interest, and not unfair to the Registrant, to proceed with the hearing in her absence.

Hearing in private
4. Mr Bellis made an application for any reference to the Registrant’s health to be heard in private.

5. The Panel had regard to the HCPTS Practice Note on “Conducting Hearings in Private” and accepted the advice of the Legal Assessor. The Panel granted the application on the grounds advanced by Mr Bellis.

Background to original Allegation and outcome of Application for Restoration

6. The Registrant began working for Mid-Yorkshire Community Rehabilitation and Intermediate Care Service at Mid-Yorkshire Hospital NHS Foundation Trust in August 2009. The Registrant was employed as a rotational Occupational Therapist and worked with community rehabilitation patients who were medically stable providing generic rehabilitation for a wide range of conditions.

7. Concerns regarding the Registrant’s capability arose in the induction period which was initially extended. The Registrant was then placed on an informal capability process for a month but by October 2009 the Registrant had not met her objectives. In November 2009, the Registrant was moved to a bedded unit. However, by December 2009, whilst the Registrant had made improvements, she was still failing to perform at the level expected of a Band 5 Occupational Therapist.

8. Between January 2010 and May 2011, the Registrant was subject to a formal capability process. However, on 18 May 2011 it was determined that the Registrant had failed to meet her objectives and she was dismissed on the grounds of capability.

9. A hearing before the HCPC’s Conduct and Competence Committee (‘CCC’) took place between 3 and 5 September 2012 which considered a number of allegations arising from the Registrant’s employment at Mid-Yorkshire NHS Foundation Trust.

10. The CCC found allegations proved which related to the following areas of practice:
• Failures to adequately manage a caseload
• Poor assessment skills
• Failures to communicate clearly and appropriately with staff members, patients and family members
• Failures in clinical competence; including failures to provide clinical reasons for actions, failures to consistently respond in a timely manner to situations, and failures in respect of prescribing and fitting equipment as well as failures to identify plans of intervention
• Failure to complete patient notes.

11. The CCC determined that the Registrant’s conduct amounted to lack of competence and that her fitness to practise was impaired. A 12-month Suspension Order was imposed by way of sanction.

12. The first review of the Suspension Order took place on 3 September 2013. The Registrant did not attend, and the Order was extended for a further 12 months.

13. The second review took place in September 2014 and the Suspension Order was further extended for a period of 12 months.

14. On 15 December 2014, the Registrant applied for voluntary removal from the Register which was granted.

15. On 1 March 2022 the Registrant applied for restoration to the Register. The Registrant submitted that at the time that the allegations had occurred she had been spent the past 11 years learning to manage her health. The Registrant stated that between 2011 and 2020 she had worked as a support worker for people with disabilities and that specifically between 2021 and 2022 she had worked within an Occupational Therapy (OT) team, undertaking a variety of interventions. The Registrant had also undertaken research and training and had reflected on her practice.

16. The CCC found that the Registrant had shown genuine remorse for her previous failures and that she had shown significant insight into what had caused those issues. However, the CCC was not persuaded at that time that the Registrant had fully remediated her failings and/or that she did not continue to pose a risk to the public despite the efforts that she had made. The CCC was however satisfied that these risks could be addressed through a Conditions of Practice Order. The Registrant was therefore restored to the Register with conditions.

17. On 27 November 2022, the Registrant informed the HCPC that she had secured work at the Leeds and York Partnership Foundation Trust (‘the Trust’) to start in January 2023 and provided the details of her manager, in line with Condition 1 of the Conditions of Practice Order. The Registrant also updated the HCPC with the details of her manager once she began work.

18. The Trust provided detailed reports to the HCPC on the Registrant’s progress and performance dated 1 April 2023, 13 July 2023, January 2024 and April 2024.

The Substantive Order Review on 24 April 2024
19. The Substantive Order Review on 24 April 2024 was attended by the Registrant.
20. On the basis of the reports from the Trust, the panel found that there were continuing concerns about the Registrant’s communication skills with patients and relatives, her clinical reasoning skills and record keeping. These had necessitated an extension to the Registrant’s preceptorship as well as her placement on a formal performance improvement plan. The Registrant acknowledged these concerns and that she was not yet ready to practise without restriction.

21. In light of these reports, the panel concluded that the Registrant’s fitness to practise remained impaired in respect of both the personal and public components.
22. The panel decided to impose a further Conditions of Practice Order for a period of 12 months but varied the conditions to provide as follows:
1. You must notify the HCPC within 7 days of any professional appointment whether paid or unpaid, which requires your registration, and provide the contact details of your employer;

2. You must allow the HCPC to exchange information with your employer and/or supervisor referred to in these conditions;

3. You must place yourself and remain under the supervision of a workplace supervisor registered with the HCPC, and, if you have not already done so, supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations;

4. You must meet with your supervisor on a monthly basis to review your performance and your progress in your Preceptorship and/or Performance Improvement Plan;

5. You must allow your supervisor to provide a report to the HCPC as to your progress every 3 months and at least 14 days prior to any review;

6. You must inform the HCPC within seven days of becoming aware of any:
• patient safety issues that you are involved in;
• investigation started against you; and
• disciplinary and/or competency proceedings.

7. You must provide a written copy of these conditions, within 7 days from the Operative Date to any organisation or person employing or contracting you to undertake Occupational Therapy work, whether paid or unpaid, which requires your registration;

8. You must not work as an Occupational Therapist for an agency or as a locum or undertake out-of hours work or on call duties without the prior written agreement of your workplace supervisor;

9. You must confine your professional practice to working for one employer; and

10. You will be responsible for meeting any and all costs associated with complying with these conditions.

11. Within six months of the Operative Date you must complete further training in the following areas:
• Communication skills
• Record-Keeping.

Today’s hearing
23. The Panel was provided by the HCPC with a hearing bundle containing the previous panel decisions and recent communications between the HCPC and the Registrant’s manager at the Trust, including the email dated 8 April 2025, stating that the Trust was unable to provide a report on the Registrant as she has been off sick from 25 June 2024 and has extended her sickness until 22 April 2025.

24. Mr Bellis submitted that, in the absence of any evidence as to the Registrant’s practice since the last Substantive Order Review hearing, her fitness to practise remained impaired with regard to both personal and public components.

25. Mr Bellis invited the Panel to consider imposing a further Conditions of Practice Order for a period exceeding 12 months on the expiry of the current order.

26. The Panel received no information or submissions from the Registrant, apart from her email to the HCPC dated 16 April 2025, in which she reaffirmed her wish to practise as an Occupational Therapist but indicated that it was unlikely that her health would permit her to do so for at least 12 months.

The Panel’s decision
27. The Panel had regard to the HCPTS Practice Notes “Review of Article 30 Orders” and “Fitness to Practise Impairment” and accepted the advice of the Legal Assessor.
28. The Panel took into account the decision of the High Court in Abrahaem v GMC where it was stated that in practical terms there is a “persuasive burden” on the Registrant to demonstrate at a review hearing that she has fully acknowledged the deficiencies which led to the original findings and has addressed her impairment sufficiently “through insight, application, education, supervision or other achievement”.

29. The Panel first considered whether the Registrant’s fitness to practise is currently impaired by reason of her lack of competence, having regard to both the personal and public components of impairment.

30. In the absence of any evidence that the Registrant had remediated her practice, the Panel had no alternative but to conclude that her fitness to practise remains impaired in respect of both personal and public components.

31. With regard to sanction, the Panel took into account the HCPC’s Sanctions Policy and accepted the advice of the Legal Assessor.

32. The Panel considered the need to protect the public and gave appropriate weight to the wider public interest, which includes the reputation of the profession and public confidence in the regulatory process. The Panel applied the principle of proportionality and considered the available sanctions in ascending order of seriousness.

33. A Caution Order would not protect the public from the Registrant’s lack of competence and was therefore not appropriate.

34. Given that the Registrant had been off sick since June 2024 and, on her own assessment, was likely to remain unfit to practise for at least 12 months, the Panel considered that a Conditions of Practice Order would not be appropriate. The Panel could not be satisfied that the Registrant had been able to maintain such limited improvement in her practice as she had achieved by the time of the Substantive Order Review on 24 April 2024.

35. The Panel decided that a Suspension Order was the appropriate and proportionate sanction, given the Registrant had demonstrated very limited progress in remediating her practice. The period of suspension would be 12 months. This should give the Registrant time to show a willingness and ability to make progress towards becoming an autonomous and safe practitioner.

36. This Order will be reviewed before the expiry of 12 months from the date of its imposition. A reviewing panel is likely to be assisted by the following:
• the Registrant’s attendance at the hearing;
• up-to-date medical evidence as to her current state of health and her fitness to return to work;
• references and testimonials in respect of any work, whether paid or unpaid, carried out by the Registrant since the date of this decision;
• evidence of any steps taken to improve her communication and record keeping skills; and
• evidence of any Continuing Professional Development undertaken.

37. The Panel gave serious consideration to the imposition of a Striking Off Order but decided, on balance, that such an order would be disproportionate at this stage. However, the Registrant should be in no doubt that this would be an option for a future reviewing panel.

ORDER: The Registrar is directed to suspend the registration of Miss Umalini Kathirgamanathan, for a period of 12 months on the expiry of the existing Order.

This Order will be reviewed again before its expiry on 13 May 2026.

Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Articles 30(10) and 38 of the Health Professions Order 2001, any appeal must be made to the court not more than 28 days after the date when this notice is served on you.

History of Hearings for Umalini Kathirgamanathan