Dylan W Williams

Profession: Chiropodist / podiatrist

Registration Number: CH10769

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 21/01/2016 End: 12:30 21/01/2016

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Podiatrist at Abertawe Bro Morgannwg University Health Board, you failed to maintain adequate records, in that:
1. A clinical audit was carried out to cover appointments between 28 March 2011 and 08 April 2011 where you were the assessing/treating Podiatrist and it was found that out of 16 electronic patient records, 15 were missing.
2. A clinical audit was carried out to cover clinic appointments at Neath Port Talbot Hospital on dates in March 2011 and notes remained incomplete as follows and it was found that:
(a) On 2 March 2011 – only three sets of notes were completed out of 18 booked appointments;
(b) On 11 March 2011 – only one set of notes were completed out of 21 booked appointments;
(c) On 16 March 2011 – only two sets of notes were completed out of 16 booked appointments;
(d) On 30 March 2011 – only one set of notes were completed out of 19 booked appointments.
3. An ongoing clinical audit was carried out to cover appointments between 18 May 2011 and 03 October 2011 where you were the assessing/treating Podiatrist, and;
(a) Notes were missing;
(b) Notes were located but entries were missing or incomplete;
(c) Notes were not completed contemporaneously, or;
(d) Notes had been taken home for completion.
4. A clinical audit was carried out to cover appointments on 8 February 2012 where you were the assessing/treating Podiatrist and it was found that:
(a) Out of 10 patient records, 5 were missing;
(b) Of the remaining 5 records, previous entries were missing.
5. A clinical audit was carried out to cover appointments between 25 and 28 June 2012 where you were the assessing/treating Podiatrist, and it was found that out of 43 patient records, no up to date electronic or paper records were available.
6. The matters set out in paragraphs 1 to 5 constitute lack of competence.
7. By reason of that lack of competence your fitness to practise is impaired.

Finding

Hearing in Private:

1. The Panel considered whether it was appropriate to hear all or part of today’s hearing in private given the fact that there may be mention of difficulties in the Registrant’s private life and health which were referred to during the hearing of 26-28 January 2015.  The Panel accepted the advice of the Legal Assessor. The Panel were mindful of the principles of open justice and the presumption that all hearings should be held in public, unless it is satisfied that it is in the interests of justice or for the protection of the private life of the Registrant.  It determined that the hearing would be held in public, but ruled that any mention of the Registrant’s private life or health should be given in private.

Background:

2. The Registrant started working as a Podiatrist for what is now known as the Abertawe Bro Morgannwg University Health Board (“the Board”) in 1995.  In 2002 he was appointed to the role of Advanced Podiatrist in Diabetes, that post subsequently being described as the Highly Specialised Hospital Podiatrist for Diabetes and Tissue Viability.  It is a post at Band 7.  At the time of the relevant matters, he regularly undertook one session at a recently established walk-in clinic at Port Talbot Resource Centre.  The remaining eight of his nine clinical sessions were treating high risk patients requiring the services of a diabetic specialist Podiatrist at Neath Port Talbot Hospital.  Concerns about the Registrant’s record keeping resulted in an audit of his records in March 2011.  Later, in 2011, Mr Williams’ session at the walk-in clinic was changed so that he undertook all of his clinical sessions at the hospital.  The allegation which the Registrant faced centred around both paper and electronic records.

3. At a hearing dated 26 - 28 January 2015 a Panel of the HCPC Conduct & Competence Committee found the Registrant’s fitness to practice was impaired due to his lack of competence, based on a ‘systematic failure in his record keeping’.  The Panel noted that, ’there is very little evidence to suggest that [the Registrant] is capable of consistent and adequate record keeping as expected of an autonomous professional’. It imposed a Conditions of Practice Order for 12 months to protect the public and to allow the Registrant, whom all parties conceded and the Panel accepted was an extremely skilled and talented practitioner, to address the failings identified and return to unrestricted practice.

Decision:

4. This is a review of the substantive Conditions of Practice Order, imposed on 28 January 2015 and which came into effect, following the appeal period, on 25 February 2015, which will expire on 25 February 2016.
5. The Panel heard representations from Ms Owusu-Akyem on behalf of the Council and Miss Price on behalf of the Registrant and accepted the advice of the legal assessor.  The Panel noted the findings of the previous Panel that the Registrant’s fitness to practise was impaired by reason of his lack of competence.

6. In undertaking its task today, the Committee is not undertaking a rehearing of the matters which were brought against the Registrant, nor going behind previous findings. The Committee reminded itself that the decision as to what is the appropriate and proportionate disposal at this review hearing is a matter for its judgment alone, and noted the requirements placed on the Registrant by the Committee on 28 January 2015 pursuant to the Conditions of Practice order regarding evidence to be produced for a future review hearing.
7. The Panel noted that the Registrant is in attendance today and wishes to remediate the failings identified by the Panel in 2015. The Registrant has not worked since May 2014 as a result of the disciplinary process undertaken at the Board resulting in his dismissal.  That process came to an end after an unsuccessful appeal against the dismissal in December 2015. He has therefore been unable to put arrangements into place in order to comply with the terms of the Conditions of Practice Order.  Thus the situation remains unchanged in terms of the Registrant’s fitness to practise.  The Panel did note that, in all other respects, the Registrant was considered to be a, ’first-rate clinician’, at the time the order was made, and that no patient suffered actual harm as a result of his actions.  Nevertheless, it was notable that the original Panel found that, ‘Against a background of wide-ranging, long-standing, repeated… failures to keep proper records… there would need to be clear evidence of a sustained period of practice with proper records being kept for [the Registrant’s] fitness to practise not to remain impaired’. In the absence of this evidence and the fact that the Registrant has now not practised as a Podiatrist for over 18 months, the Panel determined that the Registrant remains at risk of causing harm to service users by reason of his lack of competence and in the wider public interest, his current fitness to practise therefore remains impaired.

8. The Panel is aware that the purpose of any sanction is not to be punitive, though it may have a punitive effect. The Panel has borne in mind that its primary function at this stage is to protect the public, whilst reaching a proportionate sanction, taking into account the wider public interest and those of the Registrant. In so doing, the Panel has taken account of the Indicative Sanctions Guidance, applying it to the Registrant’s case on its own facts and circumstances.
9. The Panel had regard to the fact that, whilst the Registrant has kept up to date in his clinical knowledge/CPD by reading a specialised Podiatry Journal, he has been unable to practise his skills for a significant time.  Further, he has been unable to comply with any of the conditions of the original order due to the circumstances described above. Nevertheless, he is committed to continuing his career in Podiatry and is currently seeking alternative employment.
10. The Panel noted that the Registrant has now been formally diagnosed with a health condition which directly impacted upon the failings identified and that reasonable adjustments could be made, as recommended by an Occupational Therapist, to reduce (but not eliminate) the risk of repetition in a professional environment.  It is also evident that the Registrant has some insight into the need for adequate record keeping as noted by the previous Panel.
11. The Panel first considered taking no action. However, it concluded that this would be inappropriate in the absence of any evidence that the failings identified had been addressed and would therefore not be sufficient to protect service users or the reputation of the profession.  The Panel considered that this was not an appropriate case for mediation and that a Caution Order would be insufficient for the same reasons.
12. The Panel concluded that the lack of competence found in this case is still capable of remedy and therefore the extension of the Conditions of Practice Order in the same terms is the appropriate and proportionate sanction.  This will give Mr Williams a further opportunity to demonstrate that he has addressed the issues identified at the final hearing in January 2015.
13. The Panel was mindful of the need to balance the effect of the order upon the Registrant with the need to protect the public and uphold the wider public interest. It is satisfied that the order is an appropriate and proportionate response, in allowing a previously competent clinician to return to professional practice (albeit restricted by conditions) with the opportunity to address the failings identified. In these circumstances, the conditions will protect the public, it is also in both the public interest and the Registrant’s own interest to provide him with a route back into competent professional practice.
14. To test the Panel’s view that a Conditions of Practice Order is the correct order in this case, it went on to carefully consider whether the imposition of a Suspension Order would be appropriate. In the judgement of the Panel a Suspension Order would be disproportionate, at this stage, because it would not allow Mr Williams the opportunity to address the failings and it would deprive the public of a practitioner who was previously considered to be ‘an excellent clinician’.
15. Accordingly, the Panel will extend the current Conditions of Practice Order in the same terms for a period of eighteen months from the expiry of the current order.  Nevertheless, the Panel would wish to emphasise two further points which may be of assistance to the Registrant and a future Review Panel:
1. Whilst the Conditions of Practice Order is extended in the same terms as the previous order, should it become apparent to Mr Williams that the conditions are unworkable, for example (but not limited to) a circumstance where he secures a position outside the NHS, he should apply for a review within 28 days.
2. Whilst the Registrant has confirmed he is up to date with his CPD reading, he has, thus far, been out of clinical practice for a considerable period.  Therefore, in addition to compliance with the conditions, a future review panel may find it useful to receive some evidence as to how the Registrant has applied his learning in any professional or voluntary capacity whilst he seeks a professional position in Podiatry.

Order

Order:
The Registrar is directed to extend the Conditions of Practice Order against the registration of Mr Dylan W Williams for a further period of 18 months on the expiry of the existing order:

1. 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 provide professional work for which your HCPC registration is required;
b. any agency you are registered with or apply to be registered with for the purposes of the provision of professional services for which your HCPC registration is required (at the time of application);
c. any prospective employer when applying for work for which your HCPC registration is required (at the time of your application).
[For the avoidance of doubt, in the event that you engage in independent private practice, this condition (1a) does not extend to requiring you to inform individual patients seen by you during the course of that practice of this conditions of practice order. This is on the proviso that the other conditions of the order are being complied with]

2. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
 
3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer, and the outcome of the same.

4. During any period during which you are working as a Podiatrist you must place yourself and remain under the supervision of a Podiatrist working at Band 7 or above, and you must supply details of your supervisor to the HCPC within 28 days of the appointment of that supervisor. You must attend upon that supervisor as required and follow their advice and recommendations.

5. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the adequacy and consistency of your record keeping.

6. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan and to review your record keeping practice. You must ensure that there is a written summary of the matters discussed in these monthly meetings that is signed and dated by both yourself and the supervisor.

7. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

8. You must maintain on a monthly basis a reflective practice profile about your progress in your record keeping practice.

9. You must arrange for a monthly audit of your record keeping practice to be undertaken by a Podiatrist working at Band 7 or above (who may be, but need not be, your supervisor). The audit must be of records made by you personally, include at least three randomly selected clinical sessions in that month, and include all the patients seen at those clinical sessions. The outcome of each audit is to be recorded in writing and should be directed towards assessing the adequacy, standard and timeliness of your record keeping.

10. You must send to the HCPC not less than 28 days before the review of this Order the following documents:

a. The Personal Development Plan required by condition 5.
b. The written summaries of the meetings required by condition 6.
c. The monthly reflective practice profiles required by condition 8.
d. The audit reports required by condition.

Notes

The order imposed today will apply from 25 February 2016.

This order will be reviewed again before its expiry on 25 August 2017.

Hearing History

History of Hearings for Dylan W Williams

Date Panel Hearing type Outcomes / Status
07/03/2017 Conduct and Competence Committee Final Hearing Voluntary Removal agreed
09/01/2017 Conduct and Competence Committee Final Hearing Suspended
21/01/2016 Conduct and Competence Committee Review Hearing Conditions of Practice