Lyndsey J McConnell

Profession: Speech and language therapist

Registration Number: SL01609

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 02/02/2016 End: 17:00 02/02/2016

Location: Park Plaza Cardiff, Greyfriars Road, Cardiff, CF10 3AL

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Allegation:

During the course of your practise as a Speech & Language Therapist at the West
Wales General Hospital, you:

1. Failed to complete assessments adequately in that you:
a) Not Proved.
b) Failed to pick up on relevant information provided by parents, teaching staff and assistants and failed to explore these more fully.
c) Failed to prepare patients for their assessments.
d) Not Proved.
e) Not Proved.
f) Failed to demonstrate an analysis of the assessments you carried out.
g) On 4 April 2011, failed to follow a systematic approach when gathering information from the school, resulting in missing a vital piece of information regarding a patient.
h) Failed to fully explore Individual Education Programs (IEPs) and did not mention the need to add targets from your assessments into the IEPs.
i) Were unable to provide a diagnosis of a child’s articulation, after seeing the patient on four occasions.
j) Failed to re-evaluate any progress the patients have made since they were last seen.

2. Failed to communicate effectively:
a) You did not provide clear and concise explanations to patients, parents and teachers, in that you did not adequately explain to clients the assessment activity that they were to undergo.
b) You did not reassure patients’ parents where they had significant concerns.
c) Not Proved.

3. Failed to maintain adequate notes in that:
a) Your notes did not include explanation of clinical decision making.
b) Your notes did not include any rationale for assessments or a full analysis of the assessments used.
c) Your notes were written in a disorganised manner.
d) Not Proved.

4. Failed to manage your time effectively in that:
a) You took over two and half hours to complete case notes for two patients.
b) You were unable to manage a full case load.
c) You were unable to structure your assessments and patients sessions.
d) Not Proved.

5. Not Proved.

6. Not Proved.

7. Demonstrated poor clinical decision making, in that:
a) Not Proved.
b) Not Proved.
c) Not Proved.
d) Failed to give a coherent plan of action for patients.

8. Demonstrated poor management planning:
a) You failed to liaise with the classroom assistants and teachers, when making decisions in that you:
i) Did not ask their opinion on what you could do to help patients overcome difficulties.
ii) Did not ask them about the difficulties experienced in the classroom by the child.
iii) Did not explain to them the areas that you identified as being problematic.

9. Demonstrated a lack of clinical reasoning in that:
a) Not Proved.
b) Not Proved.
c) You relied too much on the previous therapist’s programme, without questioning the suitability of the objectives.
d) You were unable to provide a rationale for your choice of assessment.
e) You were unable to analyse assessment results to form clinical decisions.
f) You were unable to apply theoretical information to clinical practise.
 
10. Demonstrated a lack of judgment in that:
a) Not Proved.
b) You are unable to judge your own performance and that of others.
c) You failed to identify the learning needs of classroom assistants.
d) Not Proved.
e) You did not ascertain whether the staff you worked with had the basic skills to be able to carry out the programme being given to them.
f) Not Proved.

11. You did not demonstrate reflective practise.
 
12. The matters set out in paragraphs 1-11 amount to lack of competence.
13. By reason of that lack of competence, your fitness to practise is impaired.

Finding

 Background:
1. The Registrant was employed by the Hywel Dda Health Board (the Health Board) as a Band 7 Highly Specialist Speech and Language Therapist. She worked with a Speech and Language Therapy Department based at Glangwili Hospital in Carmarthen and Prince Phillip Hospital Llanelli. By letter dated 13 July 2006 Natalie Vanderlinden, Head of Speech and Language Therapy, was informed by the Head Teacher of one of the schools at which the Registrant worked of concerns relating to the Registrant.
2. In September 2009, Nigel Miller, a senior Speech and Language Therapist at the Health Board was asked by Ms Vanderlinden to undertake an internal investigation in relation to concerns about the working practises of the Registrant. As part of the investigation Mr Miller conducted interviews with teachers at four different schools where the Registrant worked as a Speech and Language Therapist. He then produced a report. Additionally, another Speech and Language Therapist, Ms Alison Humphrey conducted an audit in April 2010 of the Registrant’s case notes.
3. In November 2010, Ms Susan Dimmick, Head of the Speech and Language Therapy Service in Ceredigion was appointed to supervise the registrant on one day a week for a period of six weeks. Ms Dimmick prepared a report of her findings at the end of this period in February 2011. The Registrant then completed a further four week period of supervised practice in a different setting. After a third period of supervised practice the Registrant’s employment was terminated on 30 September 2011.
4. A Panel considered the allegation brought by the Council at a final hearing between the 20 and 22 August 2012. It made a number of findings of fact relating to the registrant’s competence as a Speech and Language Therapist. They related principally to inadequate completion of assessments, failure to communicate effectively, failing to maintain adequate notes, failing effectively to manage her professional time, poor clinical decision making, poor management planning, demonstrating a lack of clinical reasoning, an absence of professional judgement and a failure to demonstrate reflective practice.
5. The Panel went on to consider whether the facts found proved amounted to misconduct and/or lack of competence. It concluded that the findings amounted to a lack of competence but not misconduct. The Panel identified a number of breaches of the Council’s Standards of Proficiency for Speech and Language Therapists as well as breaches of the Council’s Standards of Conduct Performance and Ethics. It took the view that the Registrant had not been able to satisfactorily address what were considered to be ‘persistent and significant failures in key areas of professional competence, in particular those of communication and the application of clinical skills and judgement’.
6. The Panel then considered the question of sanction. It found that whilst no patients came to any harm there was ‘a significant potential of such harm had the supervisor not been present to intervene and assist as necessary.’ It recognised that the Registrant had a good level of knowledge in many areas but had reasons to doubt that such knowledge could be ‘consistently applied to her practise’ to achieve a satisfactory standard of work. The Panel acknowledged the genuineness of the Registrant’s insight but considered that it had been insufficient to effectively address her shortcomings. Careful consideration was given as to whether to impose a Conditions of Practise Order but the Panel concluded that no conditions of practise could be formulated unless there was such close supervision as to be unrealistic, unworkable and tantamount to suspension. The Panel therefore concluded that only a suspension order would be adequate to protect the public and was necessary and proportionate.
7. That Order was carefully considered by a Review Panel on 29 August 2013. That Panel took account of the considerable amount of effort made by the Registrant in the intervening period which had provided her with a degree of experience which was beginning to address the deficiencies identified in her case. It was however, in that Panel’s judgement, insufficient to adequately remediate the shortcomings in her practice. In that Panel’s opinion, although the Registrant was to be commended for the positive progress she had clearly made, she was still not in a position to be able to work as an autonomous professional and would need such close supervision that nothing less than an extension of the Suspension Order was appropriate. It therefore extended the Suspension Order for a period of 12 months.
8. That order was reviewed on 21 August 2014. That Reviewing Panel heard evidence from Mrs McConnell. It formed the view that she had demonstrated successful progress in many of the areas of concern that had been previously identified. The Panel was however not satisfied that all of the previous areas of concern had been adequately dealt with. The Panel concluded that the Registrant’s fitness to practise remained impaired. It considered that given the insight of the Registrant and her progress over the previous two years that a continuing order of suspension would be disproportionate and that the remaining level of risk could be properly dealt with by a Conditions of Practice Order. The Panel imposed a Conditions of Practice Order of 18 months.
9. This Panel is now reviewing that Order. It heard evidence from the Registrant and received a number of documents both by way of witness statements, testimonials and reports. In the Registrant’s evidence, she told the Panel of her efforts of remediation and the work that she had done in order to correct the identified deficiencies in her practice. Her Counsel specifically took her through all of the conditions and she gave evidence as to how she had complied with each condition. The Panel considered that the Registrant had made some efforts to comply, but there were outstanding deficiencies.
10. The Panel heard submissions from Ms Owusu-Akyem on behalf of the HCPC. She submitted that the Registrant’s fitness to practice remained impaired and the appropriate sanction in this case would be to extend the present Order of conditions unless the Panel considered that other conditions should be imposed. Ms Lewis, on behalf of the Registrant, submitted that because of all the matters put forward and the level of insight shown by the Registrant, her fitness to practise was no longer impaired. If however, the Panel were to consider that it was impaired the Panel should merely further extend the present Order of conditions.  

Decision:
11. In making its decision the Panel considered all of the matters put before it, both oral and written. It also took note of the Legal Assessor’s advice, which it accepted. The Panel noted a supervisor’s report made by Mrs McLaughlin, Principal Speech and Language Therapist at the Abertawe Bro Morgannwg University Health Board dated 19 January 2016. She had supervised the Registrant on 15 days between 23 September 2015 and 13 January 2016. She reported on all the matters. Her summary in the report was:
‘Mrs McConnell has been committed to developing her skills during this placement. She has attempted to respond to all the feedback that she has been given and has attempted every task that she has been given. She has made some progress, most noticeably in her ability to reflect on her actions and in her awareness of office etiquette.
Her progress in other areas such as report writing has been more limited and she will continue to require significant support with assessment, intervention, and report writing in future placements / employments.
Mrs McConnell was strongly dependant on my supervision/instruction throughout the placement. I would consider this level of supervision not to be needed by a qualified speech and language therapist.
I am aware of the longevity of concerns about Mrs McConnell’s practice as a speech and language therapist and understand that a number of steps to support her to improve her practice have been taken prior to her placement with me.
I therefore believe that the persistence of concerns about her practice, in the areas identified by the HCPC, is therefore significant.’
12. The Panel accepted this report. It noted the comments made by Ms Lewis as to the weight that they should attach to it bearing in mind that not all of the contents were accepted by the Registrant and the maker of the report was not available to answer questions. Nevertheless, the Panel considered that this was a direct report of an independent person working with the Registrant.  
13. The Panel heard the Registrant’s evidence. She did accept that there were still areas where her practice needed to improve although she did not accept all of the conclusions made by the supervisor in her report saying that the verbal feedback given to her by the supervisor was different from the conclusions contained in the report. The Panel is mindful that Ms McLaughlin prepared the report specifically for these proceedings being fully aware of the conditions that had been placed on the Registrant’s practice. The Panel accepts the conclusions made by Ms McLaughlin in her report and is satisfied that the Registrant’s fitness to practice is still impaired on the grounds of lack of competence.
14. The Panel then considered the question of sanction. The Registrant has shown some areas of improvement and some level of insight. However, both the level of improvement and the level of insight still remain limited and are of such a nature that her fitness to practice is impaired. In these circumstances the Panel considers there remains a potential risk to the public and it is therefore not appropriate at this stage for a sanction of no Order, Mediation, or Caution as those would be insufficient to protect the public.
15. The placement that the Registrant has accessed was limited in its number of days, namely one and a half days per week and also limited as to the type of Service Users that she had contact with. This may have restricted her ability to demonstrate her progress fully. She is not currently working as a Speech and Language Therapist either in a voluntary or employed capacity. She will therefore need time to find another placement as well as a suitably qualified supervisor.
16. The Panel considered that because of the efforts made by the Registrant she should be given a further opportunity to satisfy the conditions imposed by a Conditions of Practice Order and considers that such an order should be made for a period of 18 months in order to give adequate time for completion. In order for her to complete the matters referred to in condition 10 it is the Panel’s view that she will need at least 12 further months to complete the Speech and Language Competency Framework.
17. The Panel does, however, note that in this case concerns were initially raised in 2006. There have already been two Orders of Suspension, each of 12 months and one Conditions of Practice Order of 18 months. The Registrant should understand and be aware that a Conditions of Practice Order cannot be continued indefinitely. A Reviewing Panel may therefore take a different view to this Panel.
18. This Panel is satisfied that an Order of Suspension is not necessary to protect the public and would be punitive. The Panel also considers that at this stage it would be disproportionate to permanently remove the Registrant from the Register. The Panel therefore imposes a Conditions of Practice Order of 18 months. It has maintained the same conditions as the previous Order but amended some of the conditions for the purposes of clarity.
1. Within three months of returning to practise as a Speech and Language Therapist you must carry out a further 30 days of updating your knowledge and skills as described in more detail in the HCPC Information booklet entitled ‘Returning to Practice’ (‘the booklet’) except that it is a requirement of this Order that not less than 25 of these additional 30 days must be made up of ‘supervised practice’ as described in the booklet and verified by a Supervisor registered by the HCPC as a Speech and Language Therapist.
2. You must place yourself and remain under the supervision of a supervisor registered by the HCPC as a Speech and Language Therapist and supply details of your supervisor to the HCPC within 30 days of acting as a Speech and Language Therapist. You must attend upon that supervisor as required and follow their advice and recommendations.
3. 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 for professional work (at the time of application); and
c) any prospective employer in respect of your professional work (at the time of your application).
4. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
(a) Inadequate completion of assessments
(b) Communicating effectively
(c) Maintaining adequate notes
(d) Managing your professional time
(e) Professional judgement
(f) Clinical decision and clinical reasoning
(g) Reflective practice
5. Within three months of starting supervision you must forward a copy of your Personal Development Plan which has been verified by your supervisor to the HCPC.
6. You must meet with your supervisor at least on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.
7. You must allow your supervisor to provide information to the HCPC such information to be provided not less than 1 month before the date of the next review hearing about your progress towards achieving the aims set out in your Personal Development Plan.
8. You must maintain a personal reflective practice profile detailing every occasion when you meet with your supervisor and must provide a copy of that profile to the HCPC not less than 1 month before the date of the next review hearing.
9. Any condition requiring you to provide any information to the HCPC is to be met by you sending the information to the offices of the HCPC, marked for the attention of the Director of Fitness to Practice.
10. Before the end of this Order you must complete the Speech and Language Competency Framework to Guide Transition to Certified RCSLT Membership (Newly Qualified Practitioners) and this must be verified by your Supervisor.

Order

Order:

The Registrar is directed to vary the Conditions of Practice Order against the registration of Mrs Lyndsey J McConnell for a further period of 18 months on the expiry of the existing order.
The order imposed today will apply from 21 February 2016 for a period of 18 months.
This order will be reviewed again before its expiry on 21 August 2017. 
Right of Appeal:
You may appeal to the appropriate court against the decision of the Panel and the order it has made against you.  The appropriate court is the High Court in England and Wales.
Under Articles 30(10) and 38 of the Health and Social Work Professions Order 2001, an appeal must be made to the court not more than 28 days after the date when this notice is served on you. 

 

Notes

This is a Conduct and Competence Committee Substantive Review Hearing which was held in Park Plaza Cardiff on Thursday 21 January 2016 at 13:00pm and was adjourned.

The rescheduled hearing is to take place on Tuesday 2 February 2016 at Park Plaza, Cardiff at 10:00am. 

 

Hearing History

History of Hearings for Lyndsey J McConnell

Date Panel Hearing type Outcomes / Status
28/07/2017 Conduct and Competence Committee Review Hearing Struck off
02/02/2016 Conduct and Competence Committee Review Hearing Conditions of Practice