Mrs Victoria V Asirvatham

The panel at the substantive hearing found particulars 1(a)(i), 1(a)(ii), 1(a)(iii), 1(a)(iv), 1(b)(i), 1(b)(ii), 1(b)(iii), 1(c), 1(d)(i), 1(d)(ii), 1(d)(iii), 1(e)(i), 1(e)(ii), 1(e)(iii), 1(f)(i), 1(f)(ii), 1(f)(iii), 1(g)(i), 1(g)(ii), 1(g)(iii), 1(h)(i), 1(h)(ii), 1(h)(iii), 1(i)(i), 1(i)(ii), 1(i)(iii), 1(i)(iv), 1(j)(i), 1(j)(ii), 1(k)(i), 1(k)(ii), 1(k)(iii),1(l), 2(a)(i), 2(a)(ii), 2(a)(iii),, 2(c)(iii), 2(d), 3(a)(i), 3(a)(ii), 3(a)(iii), 3(b)(i), 3(b)(ii), 4(a), 4(c)(i), 4(c)(ii), 4(c)(iii), 4(c)(iv), 5(a), 5(b)(i), 5(b)(ii), 5(c), 5(d)(i), 5(d)(ii), 5(d)(iii), 6(a), 6(b)(i), 6(b)(ii), 6(c)(i), 6(c)(ii), 6(d), 6(e), 7(a)(i), 7(a)(ii), 7(a)(iii), 7(c), 7(d)(i), 7(d)(ii), 7(d)(iii), 7(e)(i), 7(e)(ii), 7(f), 7(g), 8(a), 8(b), 9(a), 9(b)(i), 9(b)(ii), 9(b)(iii), 9(b)(iv), 9(b)(v), 9(c)(i), 9(c)(ii), 9(c)(iii), and 9(d) proved, that the proven facts amounted to lack of competence, and that the Registrant’s fitness to practise was impaired.

Preliminary Matters:

Application to hold parts of the hearing in private

1. The Presenting Officer, on behalf of the HCPC, applied for this hearing to be conducted partly in private as the Registrant would be referring, during the course of the hearing, to particularly sensitive matters relating to her health and personal circumstances.

2. The Registrant was present at the hearing and supported the application.

3. The Legal Assessor referred the Panel to Rule 10(1)(a) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 as amended (the Rules). Rule 10 enables all or part of the hearing to be held in private in the interests of justice, or for the protection of the private life of “the health professional, the complainant, any person giving evidence or of any patient or client.”

4. The Panel accepted the advice of the Legal Assessor and determined that any reference to the Registrant’s health or sensitive personal circumstances should be heard in private session, in the interests of justice and to protect her private life. The Panel directed that the transcript and written determination be marked accordingly.

Background:

5. The Registrant is a registered Occupational Therapist (OT). She qualified as an OT in India in 1995 and became registered with the HCPC in 2005. On 8 December 2008 the Registrant began her employment as a Band 5 Occupational Therapist with 2Gether NHS Foundation Trust (the Trust), which provides mental health and learning disability services. She was responsible for adult patients with severe and enduring mental illness.

6. From 3 November 2014 to 2016, the Registrant was employed in the Wotton Lawn Inpatient Unit, which provides inpatient treatment for adults with mental illness who require hospital treatment due to an acute episode prior to returning to the community.

7. On 26 February 2018 to 2 March 2018, a panel of the Conduct and Competence Committee considered an allegation that the Registrant’s fitness to practise was impaired in relation to her responsibilities for eight separate service users over the period March 2015 to May 2016. The Registrant was neither present nor represented at that hearing. The panel found that the Registrant had failed in a wide range of areas of core occupational therapy skills, including the adequacy of her assessments and observations, the adequacy of her clinical reasoning, failures to initiate or implement Care Plans, and failures in respect of her case notes. The difficulties persisted despite the support provided by the Registrant’s managers in the form of a reduced caseload, a less complex caseload and supervision.

8. The substantive hearing panel also considered that the Registrant had demonstrated an alarming lack of insight. There was no evidence that the Registrant recognised the effect that her shortcomings had on service users and colleagues. The substantive hearing panel decided that the appropriate and proportionate Order was a Suspension Order for a period of 12 months.

9. At the first review hearing, the reviewing panel determined that the Registrant’s fitness to practise remained impaired and extended the period of suspension for a further 12 months. In providing its reasons for this determination, the panel complimented the Registrant on her attendance at the hearing and took the view that she was enthusiastic and motivated in relation to her role as a support worker and her desire to return to practice as an OT. However, the panel also expressed its concern that the Registrant had not appeared to understand, during the course of her evidence, that she had failed to focus on the most serious findings made by the panel at the substantive hearing. Her level of insight, the review panel added, was limited and it found no evidence that the Registrant had remediated her deficiencies to the full.

10. At the second review hearing, the panel found that the Registrant’s fitness to practise remained impaired but considered that she had gained further insight into her deficiencies and decided to impose a Conditions of Practice Order for a period of 18 months.

11. At the third review hearing, the Registrant told the panel that she had applied for Band 5 OT positions but had not yet been successful. The Registrant said that she continued to work part-time as a support worker at the Alders Clinic, a hospital providing rehabilitation for women with personality disorders and submitted a reference from her manager. She also explained that she had begun another, part-time, role as a relief rehabilitation officer at Great Western Court (GWC), a rehabilitation unit for the elderly. She continued to work as a volunteer for CRUSE bereavement care, which involved its own training, and was studying for a qualification in counselling.

12. At the third review hearing, the Registrant provided the panel with reflective case studies, appraisals and supervision records from her work and provided information about training she had undertaken for her roles and of Continuing Professional Development (CPD) training undertaken at the Royal College of Occupational Therapy. The panel saw certificates attesting to that training, including training on risk assessments for OTs. She had also obtained support and guidance with a senior OT through online sessions, which had helped her reflect on the requirements of risk assessments from an OT perspective.

13. The review panel acknowledged the proactive approach demonstrated by the Registrant but noted that she had not worked as an OT and so had not been able to demonstrate remediation in accordance with the conditions which aimed to address the concerns found proved at the initial hearing. In particular, the panel considered that the Registrant had not been able to provide substantive evidence of assessment observations, clinical reasoning, or treatment planning and observations to a standard commensurate with that expected of an OT. The review panel observed that obtaining work as an OT assistant may assist the Registrant in re-entering the profession, whilst simultaneously allowing her to undertake the return to practice requirements. The panel imposed a Conditions of Practice Order for a further 12-month period.

14. At the fourth review hearing, the Registrant told the panel that, since the third review hearing, she had not worked in an OT role. She said she had applied for two Band 5 OT posts but had not been successful because the restrictions imposed on her registration caused potential employers concern. The Registrant stated that she had accepted a Band 4 post as a Health and Wellbeing Co-ordinator with the Complex Care team of Gloucestershire Health and Care NHS Foundation Trust (the Trust). She added that she was taking an integrated approach, utilising occupational therapy skills, counselling and psychotherapy skills for the well-being of the service users. The Registrant said that she was also working alongside a Band 6 OT, LL. There was information before the panel that LL had agreed to support the Registrant with her return to practice. The Registrant said that, to meet the requirements of a Band 5 post, her understanding was that she would need refresher training in all areas because she has not practised as an OT since 2016.

15. At the fifth review hearing, the HCPC invited the panel to impose conditions of practice for a further 12 months to allow the Registrant sufficient time to acquire a placement as an OT and improve her skills to the requisite standard. The Registrant provided evidence that she had become registered as a counsellor and psychotherapist for the British Association for Counselling and Psychotherapy (BACP), and was planning to start work imminently in this new role for Great Oaks Hospice in Coleford, Gloucestershire, on a part-time basis. She was also a volunteer counsellor for CRUSE bereavement care. The Registrant did not accept that her practice was currently impaired but recognised, inferentially if not directly, that if the panel disagreed with this, she needed to continue with the steps already being taken to complete the enrolling process to join the return to practice course. She stated that she was continuing to receive help and support with this and had discussed with her mentor the topic of transferring the skills she had been honing to the role of an OT.

16. The panel was impressed by the hard work the Registrant had put in to improve her knowledge and skills, but was of the view that she did not yet fully understand the importance of fulfilling the conditions of practice as drafted. The panel was of the view that while the Registrant had developed considerable insight and shown that she is capable of making proper assessments and competent record-keeping (which the panel considered to be the centrepiece of the case), there is no evidence that she has been able to do this from the perspective of an OT. The panel commented that no clinical reasoning had been provided within the otherwise helpful documents supplied by her. The panel imposed a further Conditions of Practice Order for a period of 9 months.

17. At the sixth review hearing, the HCPC remained neutral in its position in relation to impairment of fitness to practise and any appropriate sanction order.

18. The Registrant did not consider that her fitness to practise was currently impaired. She told the panel that she had worked hard and complied with the previous panel’s requirement to successfully complete a Return to Practice Course. The Registrant was working as a Rehabilitation Officer for Gloucestershire County Council, a non-qualified role, which principally involved in admission and discharge assessments, care plans for falls, and risk assessments for COVID. She said that she worked alongside registered OTs. The Registrant said that she would aim to return to work in a registered role on a part-time basis, initially. This, in her view, would protect her own well-being, service users, and her colleagues. The Registrant accepted that she was not yet “completely equipped” to make decisions by herself and that she would want to attend training with a supervisor to help make the transition to a registered role. The Registrant invited the panel to remove the Conditions of Practice Order.

19. The panel concluded that there remained a risk of repetition of the original concerns and found the Registrant’s fitness to practise impaired on both the personal and public components. In terms of sanction, the panel considered that the Registrant’s Conditions of Practice Order, subject to amendments and variation for clarity and comprehensiveness, was appropriate and proportionate.

Today's Review Hearing:

20. The Panel today is conducting a review of the Registrant’s Conditions of Practice Order under Article 30 of the Health Professions Order 2001.

21. The Panel was provided with the following documentation:

• HCPC Bundle for Substantive Review Hearing of 194 pages, which included the previous review hearing determinations, correspondence between the HCPC and Registrant, the Registrant’s voluntary removal application.

• HCPC Addendum Bundle for Substantive Review Hearing of 63 pages, which included email correspondence between the Registrant and HCPC in relation to the Registrant’s voluntary removal application and the HCPC’s voluntary removal decision, and the following evidence provided by the Registrant for today’s Substantive Review Hearing:

a. Certificate of Attendance for Assessment Training, 24 September 2024;
b. Certificate of Attendance, BACP Counselling in NHS Talking Therapies, 5 March 2025;
c. BACP Registration Certificate confirming the Registrant is on the BACP Register of Counsellors and Psychotherapists until 24 May 2025;
d. Proof of Attendance for Pregnancy, Baby Loss and Grief, 10 October 2024;
e. Certificate of Professional Development in Working at Relational Depth in Counselling and Psychotherapy, 11 April 2024;
f. Level 2 Certificate in Preparing to Work in Adult Social Care, 15 November 2024;
g. Email from Ms Layla Jones, Lead Occupational Therapist dated 11 February 2010;
h. Application Forms and correspondence in relation to applications made by the Registrant for Occupational Therapist roles;
i. Feedback from the Registrant’s supervisor at CRUSE Bereavement Care following regular supervision sessions and performance reviews;
j. DBS correspondence;
k. Registrant’s employment contract with the Employee Resilience Company Limited dated 20 February 2025.

• A telephone attendance note dated 10 March 2025 noting the details of a conversation between the Registrant and the HCPC’s Case Manager.

Submissions:

22. The Presenting Officer on behalf of the HCPC outlined the background and history to the case and these proceedings. She referred the Panel to the Registrant’s voluntary removal application and the HCPC’s decision refusing that application. She also referred the Panel to the telephone attendance note of 10 March 2025 when the Registrant spoke with the HCPC’s Case Manager to explain her current situation, her future intentions and the possible outcomes of this review hearing. The Presenting Officer took the Panel through the Registrant’s evidence listed at paragraph 21 above.

23. The Presenting Officer outlined the Panel’s powers at Article 30 and the factors it should consider at today’s review hearing. She reminded the Panel that there was a persuasive burden on the Registrant at a Substantive Review hearing. The Presenting Officer referred the Panel to the HCPTS Practice Note on Impairment and the HCPTS Sanctions Policy.

24. The Presenting Officer submitted that the allegations relate to concerns that took place between 2015 to 2016. She referred to the previous panel’s decision and their comments in relation to remediation and insight and asked the Panel to note that panel’s concerns in relation to the Registrant not having worked as an OT since 2016. The Presenting Officer told the Panel that the Registrant has been unable to work as an OT due to her personal circumstances, but that she has made applications to work as an OT that have not been successful. Accordingly, the Presenting Officer submitted that there is insufficient evidence before the Panel to demonstrate that the Registrant has remediated the original concerns and that her fitness to practise remains impaired. She invited the Panel to extend the current Conditions of Practice Order for upto three years or to consider a Striking-off Order. The Presenting Officer went through the relevant factors as to when a Striking -off Order maybe appropriate.

25. The Registrant gave evidence.

Decision on Impairment:

26. The Panel is mindful that its task today is not to go behind the decision of the substantive hearing panel but to determine whether or not the Registrant’s fitness to practise remains impaired and if there is current impairment, what, if any, order should be made when the current order expires. The Panel considered the submissions of the Presenting Officer and the Registrant, together with the evidence and the advice of the Legal Assessor. In reaching its decision, the Panel has exercised its own independent judgement.

27. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel considered that this review required the Registrant to demonstrate both developed insight and remediation of her failings and their impact for her to be considered suitable for return to unrestricted practice. This type of review placed a persuasive burden on the Registrant to show that she has complied and fulfilled her responsibility to show she is safe to return to practice.

28. The Panel noted the steps the Registrant has taken to address the concerns raised as identified by the Presenting Officer and previous panels. It noted in particular:

• The Registrant has continued to reflect on the original concerns and continues to demonstrate remorse.

• The Registrant’s insight continues to develop and she has sufficient insight into her past failings and the impact of those failings on those in her care.

• The Registrant remains committed to the OT profession and has continued to engage with the regulatory process.

• The Registrant has provided some evidence of efforts and attempts at remediation since the last review hearing including applying for OT roles, undertaking volunteer work with CRUSE Bereavement Care that involves skills relevant to the role of an OT and direct work with service users, obtaining certificates in relation to her BACP counselling role and receiving positive feedback from her Supervisor at CRUSE Bereavement Care who states that the Registrant “continues to be a very active bereavement volunteer regularly seeing clients and completing complicated and impressive pieces of work.”

• The Registrant has been admitted as a Registrant on the BACP Register of Counsellors and Psychotherapists, despite the Conditions of Practice Order, and is working towards her accreditation. As a Counsellor the Registrant will be working directly with service users.

• At previous review hearings the Registrant had also demonstrated a proactive approach by undertaking Continuing Professional Development training at the Royal College of Occupational Therapy and risk assessment training; she had sought support and guidance from Senior OT’s; she worked as a Rehabilitation Officer for Gloucestershire Council in a non-qualified role involving in admission and discharge assessments, care plans for falls and risk assessments; and she had completed the requisite Return to Practice Course.

29. The Panel was impressed by the hard work the Registrant had put in to improving her knowledge and skills, but it was mindful that the Registrant has been unable to use her knowledge and skills as an OT and that she has not done so since 2016. The Panel noted that since the last review hearing the Registrant has applied for roles as an OT but has not been successful. The Registrant has therefore been unable to demonstrate remediation as a registered OT while subject to the Conditions of Practice Order which is specifically targeted at addressing the clinical concerns found proved. In the circumstances the Panel concluded there remained a high risk of repetition of the original concerns.

30. The Panel took into account the Registrant’s personal extenuating circumstances disclosed during her oral evidence and in her correspondence with the HCPC. The Panel recognised the Registrant has encountered difficulties in obtaining employment as an OT. It also acknowledged the Registrant’s current work, and that she is now a Registrant with the BACP; however, the Panel considered that the role of an OT has its own particular demands and responsibilities which substantially differ from the Registrant’s current roles. Therefore, the Panel concluded that the Registrant’s fitness to practise remains impaired on the basis of the personal component.

31. The Panel was also of the view that in light of the wide-ranging lack of competence found proved, and the lack of sufficient evidence of remediation, the need to uphold proper professional standards and to maintain public confidence in the profession would be undermined if a finding of impairment were not made. Members of the public would be concerned if such a Registrant, who has not practised since 2016, were able to practise without restriction.

32. Thus, the Panel found that the Registrant remains impaired on both the personal and public components.

Decision on Sanction:

33. Having determined that the Registrant’s fitness to practise remained impaired by reason of her lack of competence, the Panel went on to consider what action to take today. The Panel took into account the HCPC’s Sanctions Policy and considered its powers under Article 30(1). The Panel bore in mind that sanction is a matter for its own independent judgement and that the purpose of a sanction is not to punish the Registrant. Any sanction must be proportionate, so that it is the least restrictive order necessary to protect the public interest.

34. The Panel first considered taking no further action and allowing the Order to lapse upon expiry. The Panel determined that this was not appropriate as the Registrant’s fitness to practise remains impaired today and taking no action would neither protect the public nor be in the public interest.

35. The Panel went on to consider whether to impose a Caution Order upon the expiry of the current order. For the same reason as set out above, the Panel determined that the imposition of a Caution Order upon expiry of the current order is not the appropriate action to take today.

36. The Panel next considered the current Conditions of Practice Order and determined that it remained the appropriate and proportionate response that would protect the public and was also in the public interest. It determined that the identified deficiencies are remediable, and that the Registrant has demonstrated a genuine desire and commitment to return to the role of an OT. The Panel considered that the current conditions remained workable and measurable and enabled the Registrant to ultimately return to unrestricted safe practice.

37. The Panel considered that a sanction of suspension or striking off would be disproportionate in these circumstances where the Registrant has not been able to demonstrate remediation through no fault of her own.

38. The Panel therefore determined to extend the current Conditions of Practice Order for a period of three years. This period will allow the Registrant sufficient time, in view of her personal circumstances, to obtain a role as an OT and demonstrate that she is no longer impaired.

39. The Conditions of Practice Order will be reviewed by a panel before it expires.

The Registrar is directed to annotate the HCPC Register to show that for 3 years from the date that this Order takes effect, you, Ms Victoria V Asirvatham, must comply with the following Conditions of Practice Order. The Conditions are:

1. You must place yourself and remain under the supervision of a clinical supervisor in your workplace, who must be an OT registered by the HCPC. You must follow their advice and recommendations. You must supply details of your clinical supervisor to the HCPC within one month of beginning in a post as a registered OT. If your clinical supervisor changes, you must inform the HCPC within one month of the change coming into effect.

2. You must have monthly supervision meetings with your clinical supervisor in relation to the following areas of your practice:

a) Assessment/risk assessment;
b) Clinical reasoning;
c) Treatment planning and evaluation.

Prior to the next review of this Order, you must provide to the HCPC a written reflection, detailing your learning in relation to 2(a)-(c) above.

3. You must provide a written report from your clinical supervisor commenting on your ability to perform the OT process in respect of conducting observations; conducting assessments; devising written clinical reasoning; treatment planning and evaluation; and your record keeping standards.

4. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

5. You must inform the following parties that your registration is subject to these conditions:

A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).

The Order imposed today will apply from 30 March 2025.
This Order will be reviewed again before its expiry on 30 March 2028.

History of Hearings for Mrs Victoria V Asirvatham