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During the course of your employment as a Speech and Language Therapist with the Dundee Medicine for the Elderly Service between 3 May 2012 and 26 November 2012, you:
1. Ran a dysarthria group, but you:
a) provided service users with limited information on dysarthria; and/or
b) did not give service users information about Parkinson's Disease or other causes of dysarthria.
2. Ran a
10 week dysarthria group previously prepared by the Speech and Language Department which included weekly graded activities, but you:
a) did not follow the programme, and/or
b) produced activities:
i). which were often unstructured; and/or
ii). which were not specifically graded in task complexity.
3. Did not complete outcome forms for service user attendance at the dysarthria
and aphasia group s.
4. Did not submit all completed clinical outcome forms to the
Speech and Language Therapy Department for audit.
5. Completed clinical outcome forms which were on more than one occasion:
frequently vague; and/or
b) lacked relevant detail.
6. Displayed limited
evidence of clinical knowledge of therapy techniques in that you did not recognise the difference between ‘naming’ and ‘repetition’ when assessing Service User D. verbal discussions with the Speech and Language Therapy team.
7. Did not share important and current information about service user A with the MDT.
8. In assessing service user B, a severely dysarthric patient:
a) you used lengthy writing activities which left patient service user B too tired to complete a functional assessment of speech;
b) the assessment scores recorded on the case notes were wrongly scored incorrect and/or incomplete; and
c) you did not identify that the service user suffered from dysarthria
provide evidence of formulation, implementation and/or evaluation of treatment in service user B's notes.
d) used an inappropriate assessment tool in that it was one used for aphasia
9. Did not identify dysarthria in service user B's case notes despite it being the most significant presenting feature
9. Did not provide
direct or instruct a support worker to provide a therapy programmes to the support worker.
Frequently Input incorrect outcomes of service user attendance on the TOPAS appointment system on more than one occasion.
Often Arrived 30 minutes late for a 30 minute home visit to Service User C
a) patient service user home visits, including
i) arriving 30 minutes late for a 45 minute appointment:
b) clinic appointments.
12. Were poorly organised, in that you:
frequently had to collect resources from another room on more than one occasion:
i) shortly before sessions with service users; and/or
ii) during sessions with service users.
13. The matters set out in paragraphs 1 - 13 constitute misconduct and/or lack of competence.
14. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Panel found that there had been good service of the proceedings, in accordance with rule 3 of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003, by notice dated 15 July 2015. The Registrant is aware of the hearing today and has engaged with the HCPC process but has indicated that she does not propose to attend the hearing.
2. The Panel next considered whether to proceed with the hearing in the absence of the Registrant. The Panel was advised by the Legal Assessor to consider the guidance in the HCPC Practice Note entitled Proceeding in the Absence of the Registrant and followed that advice. It is in the public interest to proceed with the hearing and the Registrant has informed the Panel through her solicitors that she will not be attending today’s hearing and that she expects the hearing to proceed in her absence. The Panel concluded that the Registrant is aware of today’s hearing and has waived her right to attend.
3. The Registrant is registered in the Speech and Language Therapist part of the HCPC Register. She commenced employment at NHS Tayside on 3 May 2012 as a Band 6 Specialist Speech and Language Therapist (SLT). Her post was a temporary post funded via the Change Fund initiative and the funding was available until September 2013. The Registrant worked within Medicine for the Elderly (MfE) as part of a small Speech and Language Therapy team (the Team). The Registrant was managed by LC, the Team Leader. In her role she was responsible for working with service users who had acquired communication disorders, many following stroke and some due to deteriorating neurological conditions. The majority of service users were over 65 years old. She worked with service users on an individual basis and in group sessions, and she would often conduct domiciliary visits. Shortly after the Registrant commenced her role, concerns were expressed about her competence to carry out her duties. In particular, she would ask basic questions that a qualified SLT should have known, and she would often ask the same questions to various members of staff.
4. By September 2012, LC approached the Human Resources Team about the concerns she had about the Registrant’s practices and they suggested that, since she was due a Knowledge and Skills Framework (KSF) review, this was used to set clear goals for the Registrant to achieve. The KSF review took place on 28 September 2012. During the meeting, the Registrant and LC agreed specific objectives. These included increasing her knowledge of acquired communication disorders, to ensure that case notes were maintained, and the improvement of caseload management and time management skills. Despite this, there were still concerns about her competence. The Registrant resigned from her post in November 2012 and her last day in the department was in December 2012. Following her resignation, the decision was made to refer the Registrant to the HCPC. There were concerns that she had indicated she was going to continue working as a private SLT, without having addressed the concerns around her ability to work independently as a Band 6 SLT for adults with acquired communication difficulties.
5. The Registrant has provided three letters, dated 10 January 2014, 27 January 2015 and 17 August 2015 respectively, via her legal representative, Lee Biddle of BLM, in which her position has been set out. Along with these letters she has attached various documents. Within her representations, which were attached to the letter dated 10 January 2014, she says that she was having a very difficult time at work which resulted in her health and work suffering. In respect of each allegation she has indicated, via the HCPC that her fitness to practise was impaired. This has led to today’s application. She qualified as an SLT in 2008, after which she volunteered for around a year at the Chest, Heart and Stroke Scotland in Perth. From September 2009 until July 2010 she worked as an SLT at NHS borders, then between September 2010 and February 2011 as an SLT at NHS Grampian. Her next job was at NHS Tayside. She resigned from this role in December 2012. Since then she returned to part time work in January 2013 as a private and independent SLT. She continues to act in this capacity but has taken a number of steps to improve the quality of her practice. She only sees a small number of patients. Her patients are mainly children. She works fewer hours, structures her sessions and records all relevant matters. She has put in place a system of supervision by other SLTs and she has provided a number of supportive references. She has also provided two letters from Chris Robinson, Chair of Association of Speech and Language Therapists in Independent Practice Scotland and a letter from a former line manager, Louise Akhurst. She has provided her up to date CPD record as of May 2015 and the 17 August 2015 letter sets out that she has arranging an adult neurological shadowing placement.
6. The HCPC Practice Note on Consent Orders states that: The HCPC will only consider resolving a case by consent after an Investigating Committee Panel has found that there is a “case to answer”, in order that a proper assessment has been made of the nature, extent and viability of the allegation. Where the Registrant is willing to admit the allegation in full, a Registrant’s insight into and willingness to address her failings are key elements in the fitness to practise process. It would be inappropriate to dispose of a case by consent where the Registrant denied liability.
7. The task for the Panel is to determine whether to deal with the case in an expedited manner, by approving the proposal set out in the draft consent order or to reject that proposal and set the case down for a full contested hearing.
8. The Panel today has taken into account the broad public protection obligations on the HCPC imposed by the Health and Social Work Professions Order 2001.
9. The Panel is satisfied that there a case to answer based upon the decision of the HCPC Investigating Committee and the witness evidence. The Registrant has admitted the allegations and shown insight into her failings. The Panel is satisfied that by her representations and admissions and by way of the steps taken to improve her practice that the Registrant has shown insight into her failings and has sought to address them.
10. The Panel is satisfied that the conditions proposed are consistent with the expected outcome, should the matter proceed to full hearing, bearing in mind that the failings and shortcomings appear to be due to a lack of competence rather than misconduct. Therefore, a conditions of practice order would be the most appropriate and most likely outcome to address the identifiable areas of her practice in need of improvement.
11. The Panel finds that the proposed consent order provides the appropriate level of public protection. The proposed order addresses time keeping, assessments, record keeping, clinical reasoning, administration and working with adults with neurological deficits. The supervision provided for strikes a balance between protection of the public from risk of harm and the Registrant’s remediation.
12. The Panel is also satisfied that for the reasons stated above, the order would not be detrimental to the wider public interest.
13. In all the circumstances, there is no public interest in proceeding to a final hearing as the proposed conditions secure the necessary degree of public protection and meet the public interest.
14. The duration of the proposed Order of 12 months is appropriate and proportionate. The Order will be reviewed by another HCPC panel before it expires.
The Order will be review again before it expires.
The Order will be review again before it expires.
History of Hearings for Joanne Mills
|Date||Panel||Hearing type||Outcomes / Status|
|21/08/2015||Conduct and Competence Committee||Final Hearing||Conditions of Practice|