Mr Ian J Silkstone

Profession: Physiotherapist

Registration Number: PH40380

Hearing Type: Final Hearing

Date and Time of hearing: 12:30 15/01/2016 End: 14:00 15/01/2016

Location: ETC Venues, Avonmouth House, 6 Avonmouth Street, London, SE1 6NX

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Matter 1: FTP04078

 

During the course of your employment as a Physiotherapist with the Mid Yorkshire Hospitals NHS Trust between 2000 and June 2011:

 

1. You failed to complete physiotherapy records relating to children under your care in that;

(a) You failed to link documentation in your diary, case notes and on System 1 in 76 out of 106 cases prior to your suspension on 6 June 2011;

(b) You frequently failed to record patient assessments in accordance with accepted Physiotherapy Standards and trust policy.

 

2. You incorrectly advised staff members to leave gaps on the case notes in order to fill them in at a later date.

 

3. You failed to treat children under your care, which placed them at risk, in that;

(a) You failed to make appointments in a timely manner;

(b) Not proved.

 

4. You failed to carry out patient risk assessments relating to children under your care, in a timely manner, in that;

(a) Upon transference to your caseload, you failed to conduct initial physiotherapist assessments of Patients;

(i) AS;

(ii) KLC;

(iii) CA;

(b) Not proved.

(c) No evidence offered.  

 

5. No evidence offered.

 

6. You practised in a manner which was not in the best interest of Patient EL, and behaved in a way that has harmed or may have harmed Patient EL due to your physiotherapy management of that child, in that you;

(a) Not proved;

(b) Failed to complete the child’s file, making it difficult for another member of staff to pick up the case and continue providing treatment.

 

7. You practised outside of your scope of professional practice and compromised patient safety, in that;

(a) Not proved;

(b) You failed to consider patient safety when blowing out splints other than calf splints.

 

8. The matters set out in paragraphs 1 – 7 constitute misconduct and/or lack of competence.

 

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

 

 

Matter 2: FTP28169

 

During the course of your employment as a Physiotherapist with Mid Yorkshire NHS Trust, you:

 

1. Not proved;

 

2. Not proved;

 

3. Did not organise a referral to Orthotics, causing Patient JS to be wearing inappropriate AFOs;

 

4. Not proved;

 

5. Did not refer Patient LG to a Consultant Paediatrician post-surgery, placing Patient LG at risk of harm;

 

6. Did not communicate with other Healthcare Professionals regarding the treatment of Patient CI, in advance of a meeting scheduled to discuss the patient’s progress;

 

7. Did not record conversations with colleagues and patients in Patient OS’s notes;

 

8. Not proved;

 

9. Not proved.

 

10. The matters set out in paragraphs 1 - 9 constitute misconduct and/or lack of competence;

 

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

Finding

Preliminary Matters


Service of Notice

1. The notice of today’s hearing was sent to the Registrant at his address as it appeared in the register on 14 December 2015. The notice contained the date, time and venue of today’s hearing.


2. The Panel accepted the advice of the legal assessor. The Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”) require that a notice of hearing must contain the above information and be sent to the registrant at his address not less than 28 days before the date of the hearing starting.


3. Accordingly the Panel are satisfied that notice of today’s hearing has been served in accordance with the Rules.


Proceeding Absence

4. The Panel then went on to consider whether to proceed in the absence of the Registrant. In doing so, it considered the submission of Mr Byrne on behalf of the HCPC.


5. At the same time the Panel considered an application for an adjournment made by the Registrant in an email dated 14 January 2016. 


6. Mr Byrne submitted that the Registrant has engaged with the process and is aware of today’s proceedings. He drew the Panel’s attention to the letter of the Registrant dated 31 December 2015, received from the Registrant on 11 January 2016, where he states that he is unable to attend today’s hearing. He also drew the Panel’s attention to the email from the Registrant yesterday seeking an adjournment of today’s hearing. Mr Byrne submitted that the apparent purpose of the Registrant’s request for an adjournment can be inferred from his letter of 11 January 2016 wherein he asks for more time to obtain supervision and demonstrate that he is able to, and has fulfilled, the requirements of the Order. Mr Byrne drew the Panel’s attention to the passage where the Registrant stated:


As I have not yet fulfilled the conditions placed upon myself, I would very much appreciate an extension to the time frame in order to allow me to undertake supervision and seek employment. I feel by this time next year I could have successfully complied with all aspects of my sanctions.’


7. Mr Byrne submitted that an adjournment would serve no useful purpose as the HCPC are not seeking to convince the Panel that it should do anything other than to extend the period of the current Order to allow the Registrant to comply with the terms of the Order. Mr Byrne submitted that is what the Registrant would appear to be seeking at the next hearing if an adjournment were granted and he was in attendance, on the basis that there has been no change in circumstances since the last hearing.


8. Mr Byrne submitted that in the circumstances, and bearing in mind that there is the public interest in this order being reviewed before its expiry, it was fair and in the interest of justice to proceed in the Registrant’s absence. He drew the Panel’s attention to the HCPC’s Practice Note on Proceeding in the Absence of the Registrant and the HCPC’s Practice note on Adjourning and Postponing Proceedings. He submitted that there would not be any unfairness if it was to proceed today in the absence of the Registrant and that there was a public interest in proceedings being dealt with expeditiously. He reminded the Panel that the Order is due to expire on 27 February 2016 and needs to be reviewed before then.


9. The Panel accepted the advice of the Legal Assessor. He advised that if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing then the Panel has the discretion to proceed in the absence of the Registrant. He reminded the Panel that it should exercise that discretion with the utmost care and caution. He drew the Panel’s attention to the principles to be considered when exercising the discretion to proceed in the absence of the Registrant as outlined in the case of R v Jones [2002] UKHL 5. He further advised that the Panel can consider the issue jointly with the Registrant’s application for an adjournment. He drew the Panel’s attention to the case of R v Picton [2006] EWHC 1108 (Admin) which sets out some of the relevant considerations when deciding applications to adjourn proceedings. He advised that the Panel must consider the nature and circumstances of the Registrant absenting himself, in particular whether the decision was voluntary and if so, whether the he had waived his right to be present and/or represented. The Panel should also consider what would be achieved by adjourning these proceedings; and the general public interest that the Order be reviewed before it expires.


10. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of today’s hearing. It is also satisfied that the Registrant is aware of today’s hearing.


11. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPC practice note entitled ‘Proceeding in the Absence of a Registrant’. It weighed its responsibilities for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.


12. In reaching its decision the Panel took into account the following:


• The Registrant’s application for an adjournment which appears to be based on his intention to attend and ask for an extension of the Order.
• The Registrant has engaged with the process and has submitted further written representations;
• There is a public interest that this substantive order is reviewed before it expires.


13. Bearing this in mind and the fact that the Order is due to expire on 27 February 2016, the Panel determined that it is fair and in the public interest that the matter proceeded today in the Registrant’s absence. There would be no unfairness to the Registrant as he has, in effect, made his submissions by way of his letter dated 31 December 2015.


Background


14. The Registrant was employed by Mid Yorkshire NHS Trust (the Trust) between 1989 and 2011. He was a Band 7 Paediatric Physiotherapist from 2000. He worked within the Child Development Centre (CDC) at Dewsbury Hospital and held a caseload consisting of children with physical and learning difficulties attending mainstream schools, children suffering from talipes (Club Foot), and children on an inpatient ward. The Registrant also provided physiotherapy cover for the Children’s Ward at Dewsbury Hospital.


15. Towards the end of May 2011, while the Registrant was on annual leave, parents of children in his caseload telephoned the CDC and requested updates on their children’s physiotherapy treatment and progression. The Registrant’s colleagues, Colleague 2 and PC, tried to assist parents with their enquiries and reviewed the relevant patient notes.


16. Upon review, Colleague 2 and PC noticed that the Registrant had failed to write up patient notes, conduct patient assessments and formally record all physiotherapy interventions with the patients, as was required by the Chartered Society of Physiotherapy (CSP) Core Standards of Physiotherapy Practice.


17. These concerns were raised with Colleague 1 who conducted a preliminary investigation into the Registrant’s diary and patient notes. After noting discrepancies within the notes and the treatment provided to patients, Colleague 1 escalated the concerns to Trust management. The Registrant was suspended from the Trust with immediate effect on 1 June 2011.


18. The Trust launched a full investigation and TR, a Band 7 Physiotherapist, was tasked with conducting an audit of the Registrant’s note keeping and assessment compliance in respect of his mainstream and talipes caseloads. Following concerns raised during the audit about the treatment provided by the Registrant, the Trust issued a Serious Untoward Incident (SUI) case review and all 206 of the Registrant’s patients were recalled for assessments. On review, 17 paediatric patients were identified as potentially suffering from deterioration in their condition.


19. The Trust commenced disciplinary proceedings and the disciplinary hearing took place on 9 and 15 December 2011. On 19 December the Panel announced their decision that the Registrant would be dismissed from the Trust with immediate effect as he exhibited “extensive, fundamental clinical failings that may have resulted in serious potential harm to children”. The Trust referred this matter to the HCPC on 7 February 2012


On 30 January 2015, a panel of the Conduct and Competence Committee of the HCPC found a number of allegations brought against the Registrant proved. Further, the Panel determined that those allegations amounted to misconduct and a lack of competence and imposed a Conditions of Practice Order against the Registrant’s registration for a period of 12 months.


Decision:


20. This is a review under Article 30 of the Health and Social Work Professions Order 2001 of the abovementioned 12 months Conditions of Practice Order imposed on the Registrant’s registration.


21. The Panel considered the submissions made by Mr Rory Byrne on behalf of the HCPC. He outlined the background to the case and submitted that whether the Registrant remained impaired is a matter for the Panel as was the matter of what action to take if the Panel found impairment today. He submitted that it was the HCPC’s case that the Registrant remained impaired as he has been unable to fulfil the requirements of the Order, and the Registrant appears to accept this to be the case as evidenced by the contents of his letter of the 31 December 2015.


22. The Panel accepted the advice of the Legal Assessor. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive appraisal of the Registrant to determine if he is fit to return to unrestricted practice. Its role is not to conduct a rehearing of the allegations nor is it to go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment.


23. The Legal Assessor advised the Panel that, if it determined that the Registrant’s fitness to practise remained impaired, all the options under Article 30 of the 2001 Order could be exercised by the Panel. He advised the Panel that it should bear in mind the principle of fairness and proportionality and have regard to the Indicative Sanctions Policy document issued by the HCPC. He reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or is otherwise in the public interest.


24. He reminded the Panel that the previous panel also considered the imposition of a Suspension Order and determined that such a sanction would be disproportionate at that time.


25. The Panel took into consideration all the documentation before it, and the submissions of Mr Byrne and Mr Silkstone as contained within his letter dated 31 December 2015.


26. The Panel determined that the Registrant’s fitness to practise remains impaired as there is effectively no change in circumstances since the substantive hearing and the Registrant has not provided any new information which leads the Panel to think otherwise.


27. The Panel recognises Mr Silkstone has tried to obtain supervision but has not been successful so far. In the light of this, the Panel accepts that the Registrant is still committed to remaining in the profession.
28. The Panel considered what action to take today in light of the finding that the Registrant’s fitness to practise remains impaired. The Panel took into account the HCPC’s Indicative Sanctions Policy document and considered its powers under Article 30(1).


29. It 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.


30. The Panel went on to consider whether to impose a Caution Order upon the expiry of the current order. For the reason 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.


31. The Panel next considered the appropriateness of the current Conditions of Practice Order and determined that it remained the appropriate and proportional response that would protect the public and also protect the public interest. In these circumstances, the Panel determined that the appropriate action to take today is to further extend the period for which this Order has effect by 15 months.


32. The Panel considered making an order for suspension but considered that this would be disproportionate taking into account in particular the Registrant’s engagement with the process.


33. The Panel have also determined to make the following amendments to the terms of the Order:


Condition 1- The sentence “The supervisor must be someone who has not had any involvement with the present case” is deleted.


Condition 6 is to be added and reads as follows:


6. Not less than 28 days before the next review hearing, you must forward to the HCPC a report from your supervisor detailing the following:


a) Frequency of your meetings with him or her;
b) The topics and issues discussed at each meeting; and
c) What progress has been made towards meeting the objectives contained in your Personal Development Plan.

Order

Order:  The Panel varied the existing Conditions of Practice Order imposed on for a further 15 months. The Order will be reviewed again before its expiry. The conditions imposed are as follows:


1. You must place yourself and remain under the supervision of an appropriate senior physiotherapist registered by the HCPC and supply details of your supervisor to the HCPC within 1 month of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.


2. You must promptly inform the HCPC if you take up any physiotherapist employment.


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 (at the time of application); and
C. any prospective employer (at the time of your application).


4. You must work with your supervisor to formulate a Personal Development Plan (PDP) designed to address the deficiencies in the following areas of your practice:


• Documentation of major patient assessment, e.g. initial assessments;
• Using and recording of SOAP notes;
• Accurate recording of all contact with patients’ parents and carers, and fellow professionals relating to your clinical practice;
• Awareness of CSP core standards


  Within three months of the Operative Date you must forward a copy of your PDP to the HCPC.


You must meet with your supervisor, at least on a monthly basis, to consider and document your progress towards achieving the aims set out in your Personal Development Plan.


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.


You must submit evidence that the PDP has been completed counter-signed by your supervisor to the HCPC one month before the review hearing.
 
5. It is recommended that these documents form part of a CPD folder in which you could demonstrate:


• Reflective practice;
• The learning points from your supervised practice
• Relevant and up-to-date clinical knowledge


6. Not less than 28 days before the next review hearing, you must forward to the HCPC a report from your supervisor detailing the following:
a) Frequency of your meetings with him or her;
b) The topics and issues discussed at each meeting; and
c) What progress has been made towards meeting

Notes

This Order will be reviewed before it expires.

Hearing History

History of Hearings for Mr Ian J Silkstone

Date Panel Hearing type Outcomes / Status
12/04/2017 Conduct and Competence Committee Review Hearing Struck off
15/01/2016 Conduct and Competence Committee Final Hearing Conditions of Practice