Mrs Ishwari Sen

Profession: Physiotherapist

Registration Number: PH68151

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 21/12/2016 End: 17:00 21/12/2016

Location: Health and Care Professions Council, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: No further action

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Allegation

During the course of your employment as a Physiotherapist with United Lincolnshire Hospital NHS Trust:

1)    On 2 June 2014, upon observation of injuries to Service User A and receipt of information regarding the welfare of Service User A from Service User A's Grandmother:

a)    You did not notify and/or pass this information on to a manager; and/or;

b)    You did not speak to the Safeguarding team for advice, and/or;

c)    You did not contact Children’s Services for advice.

2)    On 5 June 2014, upon receipt of a telephone call from Service User A’s Grandmother regarding the welfare of Service User A:

a)   You did not notify and/or pass this information on to a manager and/or;

b)    You did not speak to the Safeguarding Team for advice, and/or

c)    You did not contact Children’s Services for advice.

3)    On 9 June 2014, upon receipt of a telephone call from Service User A’s Grandmother regarding both Service User A and his sister’s welfare:

a)    You did not notify and/or pass this information on to a manager; and/or

b)    You did not speak to the Safeguarding Team for advice, and/or

c)    You did not contact Children’s Services for advice.

4)    You sent a letter to Service User A’s General Practitioner dated 13 June 2014 regarding the injuries observed and information you received described in paragraph 1 a), in which you made inappropriate assertions as to the cause of Service User A’s injuries that were beyond your remit.

5)    You sent the letter 11 days after the appointment with Service User A during which safeguarding concerns were first reported to you by his Grandmother:

6)    The matters described in paragraphs 1-5 constitute misconduct and/or lack of competence.

7)    By reason of that misconduct and/or lack of competence your fitness to practise is impaired.

Finding

Background

1. At the time of the allegation the Registrant was employed by United Lincolnshire NHS Trust as a Band 6 Paediatric Physiotherapist based at Lincoln County Hospital. The Registrant was responsible for children admitted to the hospital paediatric wards in need of physiotherapy intervention and those attending as outpatients. She was also the Physiotherapy Children’s Safeguarding Champion.

2. Service User A was referred to the Physiotherapy Department by his GP in March 2014 having had a two to three year history of right parascapular pain. On 2 June 2014 Service User A attended a physiotherapy appointment with his grandmother. The appointment was with the Registrant. During the appointment the Registrant made a note that the grandmother alleged that Service User A had undergone physical abuse over a four year period by his mother’s boyfriend.

3. On 5 June 2014 the Registrant made a note of a telephone conversation with the grandmother in which the grandmother informed her that there was a history of physical trauma at the end of December 2013 involving the boyfriend of Service User A’s mother. She claimed that an injury to Service User A’s arm was caused by a fall and his mother had lied about the circumstances to the authorities.

4. On 9 June 2014 there was a further note by the Registrant which referred to another call from Service User A’s grandmother. The grandmother requested that the Registrant write a report and forward it to Service User A’s GP for use in court proceedings concerning Service User A. During that telephone call the grandmother also disclosed that Service User A had a two and a half year old sister who was also being physically abused by the mother’s boyfriend.

5. On 13 June 2014 the Registrant sent a letter to Service User A’s GP. In the letter she outlined the information that the grandmother of Service User A had disclosed to her on 2 June 2014 and in the subsequent telephone calls. At the end of the letter the Registrant concluded that she was “inclined to feel that the injuries…..may have been caused following the abuse”.

6. The allegation was considered by a Final Hearing Panel at a hearing on 14 and 15 December 2015. The Registrant admitted the factual allegations and the Final Hearing Panel found that the Registrant did not, on receipt of the telephone calls, notify or pass the information to a manager, speak to the Safeguarding Team or contact Children’s Services for advice. Further the Registrant’s letter to Service User A’s GP dated 13 June 2014 made inappropriate assertions as to the cause of Service User A’s injuries that were beyond the Registrant’s remit.

7. The Final Hearing Panel found that the Registrant knew what she should have done and failed to do so, having made an assumption that the information provided by Service User A’s grandmother was accurate, namely that Social Services were already engaged and court proceedings were ongoing. The Panel found that the contents of the Registrant’s letter to the GP were seriously inappropriate in expressing an opinion which was outwith her scope of practice, particularly so where the Registrant was aware the letter was to be used for the purposes of court proceedings where significant decisions are made about the welfare of children. In addition the Registrant’s letter caused inappropriate and unnecessary concerns for both Service User A’s mother and Social Services. The 11 day delay in taking any action was completely unacceptable and potentially put children at risk of harm. Action should have been taken on the day the information was first disclosed. The Panel found that the Registrant’s actions were serious and amounted to misconduct.

8. The Final Hearing Panel found that the Registrant demonstrated some insight in her written statement and her live evidence. However, she was unable to fully explain to the Panel why she made the misjudgement of relying on the information provided by the grandmother when, in safeguarding, the crux of the matter is not to take information at face value and to share with other professionals who are in a position to check the information. The Registrant demonstrated some remorse, but this appeared to relate more to the writing of the letter to the GP as opposed to her failure to act. The Registrant was not able to provide a satisfactory explanation for the delay of 11 days in writing the letter or why she recorded in the notes of 9 June 2014 that she would contact the Safeguarding Team and did not do so until 31 July 2014. The Registrant produced evidence of one e-learning module of refresher safeguarding training which she undertook on 5 October 2015.

9. The Final Hearing Panel was of the view that, given the severity of the Registrant’s failings, her limited evidence of training and reflection was insufficient for her to have fully remediated her failings and there was therefore a risk of repetition. The Final Hearing Panel also concluded that the Registrant’s behaviour constituted a serious departure from the standards expected of a health professional and that the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in these circumstances. The Final Hearing Panel concluded that the Registrant’s fitness to practise was impaired.

10. The Panel decided that a Conditions of Practice Order for twelve months would be an appropriate sanction. The Panel was satisfied that, subject to these conditions, the Registrant was capable of safe and effective practice.


The Conditions of Practice were:

1. Within three months of the Operative Date you must (1) attend in person and satisfactorily complete a course (not e-learning) on Safeguarding of at least one day’s duration and (2) forward a copy of evidence of your attendance to the HCPC within fourteen days of your attendance.

2. Within two months of your completion of the course, you must submit to the HCPC a written reflective piece covering what you have learned from the course; what insights you have into the failings as found by this Panel and how your learning will be applied to your current practice.

3. Within two months of the Operative Date, you must provide to the HCPC a copy of your written safeguarding guidelines setting out the management of safeguarding issues within your private practice.

4. You must work with a clinical supervisor to formulate a Personal Development Plan (PDP) designed to address the learning needs which have been identified in relation to safeguarding and forward a copy of your PDP to the HCPC within three months of the Operative Date. Your clinical supervisor must be a senior, experienced physiotherapist of at least Band 7 of above.

5. You must meet with your supervisor at least once every two months to consider your progress towards achieving the aims set out in your PDP.

6. You must allow your Supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your PDP.

7. You must provide the HCPC with a report from your supervisor about your progress towards achieving the aims set out in your PDP not later than 28 days and not earlier than 56 days before this order is reviewed.

8. You must provide to the HCPC a written reflective piece demonstrating what you have learnt since the Panel’s determination and in particular how you have dealt with any safeguarding issues which may have arisen in your practice not later than 28 days and not earlier than 56 days before this order is reviewed.

9. 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 physiotherapy work;
b) any agency you are registered with or apply to be registered with as a physiotherapist (at the time of application)
c) any prospective employer (at the time of application) of your services as a physiotherapist.

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

Decision

11. The Registrant provided evidence that she has complied with the Conditions of Practice. The evidence provided to the Panel was:

• A certificate of completion of a two day safeguarding course (Interagency Safeguarding) February 2016;
• reflective statements dated 13 March 2016 and 23 November 2016
• The Registrant’s draft of Safeguarding guidelines for the private practice clinic where the Registrant worked;
• A supervisor’s report confirming that he has met regularly with the Registrant to discuss her PDP plan and that the Registrant “has worked hard to focus on safeguarding issues and has the knowledge ability and skills to fully comply with any safeguarding issues going forward.”

12. On behalf of the HCPC Ms Owusu-Aykem submitted that the Registrant has complied with the Conditions of Practice and that her fitness to practise is not currently impaired.

13. The Registrant gave oral evidence to the Panel and referred to her written, signed witness statement.  She outlined the meetings with her supervisor and the work she has undertaken while she has been subject to the Conditions of Practice Order.

14. The Registrant has not undertaken any private practice work since her Conditions of Practice Order was imposed. From 8 August 2016 the Registrant was employed by the London Teaching Pool Ltd. She completed a three month locum assignment at the Royal Buckinghamshire Hospital as a Band 6 Physiotherapist working with adult patients. The Registrant provided the Panel with positive testimonials from a Senior Recruitment Consultant at the London Teaching Pool Ltd and from a Senior Physiotherapist at the Royal Buckinghamshire Hospital. In the locum position the Registrant delivered two training courses which were well received.

15. The Registrant outlined to the Panel her plans for the future. She has been offered permanent employment commencing in January 2017 at the Royal Buckinghamshire Hospital undertaking the same work she undertook during her locum assignment. She explained to the Panel that she believes that this role is suitable for her and that she has no current plans to undertake private practice work. She expects that she will be required to attend supervision every six to eight weeks.

16. The Registrant has complied with the Conditions of Practice which were intended to provide a period of remediation and rehabilitation. In answer to questions from the Panel the Registrant demonstrated that she has learned lessons from the safeguarding training course which she attended in February 2016. For example, she referred to the different types of abuse that may occur. Although the Registrant has not worked in an area where safeguarding issues have arisen, she has discussed these issues with her supervisor and she has herself prepared the safeguarding guidelines for private practice work and discussed them with her supervisor. The Registrant also demonstrated that she understood the importance of supervision and explained that she would make arrangements for supervision if she carried out any private practice work in the future.

17. In the Panel’s assessment the Registrant demonstrated insight in her reflective statements and in her evidence to the Panel. The Panel is therefore of the view that the Registrant has remedied the deficiencies identified by the Final Hearing Panel. The Panel was therefore satisfied that the risk of repetition of similar misconduct is low.

18. The Panel considered the wider public interest considerations. There is no ongoing risk to public safety. The public interest in upholding standards of conduct and maintaining confidence of the profession have been met by the imposition of the Conditions of Practice Order and the Registrant’s full compliance with the conditions. It is in the public interest to allow a skilled practitioner who has remediated the deficiencies in her practice and demonstrated insight to return to the profession.

19. Considering both the personal component and the public component the Panel concluded that the Registrant’s current fitness to practise is not impaired. The Panel therefore make no further order and the Conditions of Practice will cease to apply when they expire on 12 January 2017.

Order

No order - the Panel finds the Registrant's current fitness to practise not impaired and the Conditions of Practice will cease to apply when they expire on 12 January 2917.

Notes

A Substantive Review of the Conduct and Competence Committee  was held in London on 21 December 2016. The Registrant's fitness to practise was found to be unimpaired.

Hearing History

History of Hearings for Mrs Ishwari Sen

Date Panel Hearing type Outcomes / Status
21/12/2016 Conduct and Competence Committee Review Hearing No further action
14/12/2015 Conduct and Competence Committee Final Hearing Conditions of Practice