Mrs Joy Lytham

Profession: Operating department practitioner

Registration Number: ODP32487

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 12/07/2016 End: 16:00 12/07/2016

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Allegation found proved at final hearing
During the course of your practice as an Operating Department Practitioner with Harrogate and District NHS Trust:
1. Between 5 and 6 April 2012 you were unable to demonstrate sufficient knowledge of basic procedures relevant to your role in that you:
(a) did not have suitable laryngoscopes available
(b) did not have a bougie available despite the Anaesthetists requests
(c) were unable to set up a capnograph or arterial line
(d) did not know how to zero an arterial line
(e) did not apply cricoid pressure for a rapid sequence induction
(f) did not demonstrate independent judgement of what action was required.
2. On 12 July 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you were unable to:
(a) check the set-up for the specialist needs of the patient in that you did not:
(i) prepare fluids for administration to the patient by running them through the giving set;
(ii) make ready a rapid infuser [ADMITTED]; 
(b) correctly prepare airway management equipment for the situation in that you:
(i) did not cut the ET tubes;
(ii) did not attach a syringe for rapid sequence induction;
(iii) did not prepare the difficult intubation trolley;
(c) safely assist the clinician with intubation procedure in that you released cricoid pressure during intubation
(d) [NOT PROVED]
(e) prepare for CVC monitoring [ADMITTED]; (f)  demonstrate how to recognise:
(i) tension pneumothorax [ADMITTED];
(ii) [NO CASE TO ANSWER]
(g) adapt to a changing situation in that:
(i) you were unable to determine the cause of the patient’s cardiac arrest [ADMITTED];
(ii) you were unable to deliver effective chest compressions [ADMITTED];
(h) provide a competent handover of care to the PACU team
(i) [NOT PROVED]
(j) [NO CASE TO ANSWER]
3. On 10 August 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you were unable to:
(a) check the anaesthetic machine correctly as part of its set up;
(b) check the set-up for specialist needs of the patient in that you did not
(i) take account of the patient’s low body temperature [ADMITTED];
(ii) make correct adjustments for intubation where a hard collar was in situation;
(c) correctly prepare airway management equipment for the situation
(d) safely assist the clinician with intubation procedure in that you:
(i) released the syringe during the intubation procedure;
(ii) removed the patient’s hard collar to facilitate intubation;
(iii) rolled the patient onto their side whilst a hard collar was not in situ;
(e) demonstrate awareness of or discuss alternative techniques for airway management
(f) prepare for CVC monitoring and/or arterial line insertion [ADMITTED]
(g) undertake a collection of arterial blood and provide basic interpretation of gas results;
(h) adapt to a changing situation in that you did not notice the patient was in cardiac arrest for seven minutes;
(i) assist with cardiac arrest management in that you used an ineffective CPR technique [ADMITTED];
(j) [NO CASE TO ANSWER] (k)  [NO CASE TO ANSWER]
(l) provide a competent handover of care to the ODP for transfer in that you did not:
(i) explain that the patient had undergone cardiac arrest;
(ii) communicate the treatments and drugs that had been administered to the patient [ADMITTED].
4. On 11 October 2012 (during assessment of your skills as an Operating Department Practitioner) you were unable to practise at the required level of competence of a band 5 Operating Department Practitioner in that you:
(a) [NOT PROVED]
(b) did not communicate adequately to the anaesthetist
(c) were unable to use the pressure infuser device correctly
(d) were unable to select the correct drugs for RSI in preparation for the anaesthetist arriving
(e) were unable to deliver chest compressions at the correct ratio [ADMITTED].
5. [NO CASE TO ANSWER]

Finding

This is the second review of the sanction imposed on 14 May 2014. Initially the sanction was a Conditions of Practice Order for a period of 12 months. The first review of the sanction took place on 5 May 2015 and the Conditions of Practice
Order was replaced with a Suspension Order for a further period of 12 months.
The sanction was due to be reviewed for a second time on 6 May 2016 but the Panel on that date determined to adjourn the review in order to allow the Registrant to attend. In doing so, that Panel further extended the Suspension Order for a further period of two months from 11 June 2016. Therefore the Order is due to expire on 10 August 2016.

Background
1. On 26 August 2009 the Registrant was employed at Harrogate District Hospital as an Operating Department Practitioner (ODP). In this role, the Registrant was based in the Main Theatres as an expert assistant to surgeons and anaesthetists both during surgical procedures and whilst patients were in recovery.
2. On 11 October 2010, informal capability proceedings were instigated in relation to the Registrant in response to a number of complaints that had been made by colleagues about the Registrant’s apparent inability to understand or fulfil the requirements of her role.
3. As part of the capability process, key competencies were outlined as objectives for the Registrant to achieve. The Registrant worked in a supernumerary capacity throughout the informal capability process. On 2 March 2011, the informal capability process was lifted, allowing the Registrant to work autonomously on standard shifts (excluding nightshift).
4. On 6 April 2012, a complaint was made regarding the Registrant's performance during treatment of a patient in a resuscitation bay. The complainant was concerned regarding the Registrant's ability to prepare and set up standard equipment, or demonstrate necessary competence during procedures.
5. The Trust's formal capacity process was initiated and an action plan was agreed on 24 May 2012 leading to an assessment on 12 July 2012. The Registrant did not complete the assessment satisfactorily. 
6. A revised action plan was devised leading to a second assessment on 10 August 2012, which the Registrant did not satisfactorily complete.
7. The third assessment took place on 11 October 2012, which the Registrant also failed to complete satisfactorily.
8. At the end of the Capability Hearing on 23 November 2012 the Trust decided to dismiss the Registrant. The Registrant was referred to the HCPC and the Final Hearing took place on 6 to 14 May 2014.
9. The particulars of allegation set out above were found proved, in part by way of admissions and in part by way of evidence produced by the HCPC.
 
Decision:
10. Mr Thompson, today, on behalf of the HCPC, outlined the background of the case and the previous reviews to the Panel. He submitted that the Registrant’s fitness to practise remains impaired as there is no evidence to show that the lack of competence in the Registrant’s practice has been remedied. 
11. Mrs Lytham gave evidence on oath. She told the Panel that she was currently employed as a Band 2 Care Support Worker (“CSW”) at Leeds Teaching Hospital NHS Trust (“the Trust”). She had been employed in that capacity since 2014 and when the Conditions of Practice were imposed she had continued in that capacity but was given the opportunity by the Trust to undertake training to develop and demonstrate her ability to operate independently as a Band 5 ODP, whereupon she could be employed as a Band 5 ODP.
12. Mrs Lytham told the Panel that the first review of the Conditions of Practice Order took place in May 2015 before she had completed 6 months of training and therefore she had not been able to complete the competency requirements before the HCPC review date, at which a Suspension Order was imposed. She told the Panel that the difficulties on the third placement arose because the mentors could not understand her status. She told the Panel that those mentors continuously expected her to operate as an independent practitioner which she was not able to do, especially because she was not employed as one, and also because her ability to practise as an ODP had been suspended by the HCPC. She explained as a result, she was unable to meet the expectations of her mentors and that was the reason for the negative reports
13. In response to questions put to her, the Registrant told the Panel that she believed that her fitness to practise was no longer impaired and that she was
able to return to safe practice without restriction. She told the Panel of the courses that she had attended within the Trust.
14. The Panel accepted the advice of the Legal Assessor. The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review of the Order to determine if the Registrant 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.
15. The Legal Assessor advised that the Panel might find the questions formulated in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) of some assistance, albeit slightly modified for these proceedings:
‘Does the evidence before the Panel today show that the Registrant’s fitness to practise remains impaired in the sense that she:
a) is liable in the future to act so as to put a service user at unwarranted risk of harm; and/or
b) is liable in the future to bring the Operating Department Practitioner profession into disrepute; and/or
c) is liable in the future to breach one of the fundamental tenets of the profession. 
16. The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired then the Panel must go on to consider what sanction, if any, should be imposed. The Legal Assessor advised that the Panel could exercise all options under Article 30 of the 2001 Order, except for the option of striking the Registrant’s name from the Register. He advised that a ‘striking off’ Order cannot be imposed because the Registrant has not been continuously suspended for a period of at least two years, nor has she been subject to a Conditions of Practice Order for a period of at least two years. 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.
17. The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, the oral evidence of the Registrant and the submissions of both parties. In particular it noted the following: 
a) The engagement of the Registrant with the process and her commitment to remaining in the profession;
b) The assessment reports before it, the most recent being from Ms JI, Head of Nursing, Theatres and Anaesthetics CSU of the Trust dated 18 April 2016;
c) The Trust has not employed the Registrant as an ODP since 2014. Instead it employed her as a Band 2 CSW and provided her with mentoring and training as if she were a Student Operating Department Practitioner;
18. The Registrant has not provided any certificates of the courses she attended at the Trust, nor has she brought any testimonials to attest to her ability to work independently as an ODP, nor any evidence to demonstrate that she has remediated the shortcomings in her practice identified by the previous Panels.
19. One of the shortcomings in the Registrant’s practice appears to be the inability to take initiative action. Whilst the Panel recognises that the Registrant was not employed as an ODP at the Trust since the imposition of the Suspension Order, the Panel determined that there would have been opportunities within that role for the Registrant to demonstrate initiative on her part when working with an ODP, for example by making suggestions to the ODP. However, the Registrant has not provided any examples of her demonstrating initiative.
20. The Registrant lacks any insight into the shortcomings in her practice. She fails to recognise that the duration for which she has not been practising as an ODP would have an effect even on the most competent of ODPs. Following her placement in August 2015, the Registrant has not completed any training that relates to the practice of the Operating Department Practitioner profession. She has not given evidence of any relevant reading, job shadowing, and/or personal study that might give some level of confidence into the insight of the Registrant or her attempts to recognise and remediate the shortcomings in her practice.
21. The Panel has seen evidence of the competencies within the Competency Framework being signed off. However, evidence from the Registrant’s mentors endorsed by JI indicated that the Registrant appears to be unable to integrate these individual competencies into safe and effective daily practice as an ODP.
22. The operating theatre environment is a fast moving environment where risk and unpredictability are ever present. As such, the need to be able to adapt promptly to unexpected situations and crises is paramount to ensure the safety of patients. No evidence has been presented to the Panel that could demonstrate that the Registrant is able to work competently in such an environment. On the contrary, the evidence before the Panel today, demonstrates that the Registrant is currently unable to cope in such an environment.
23. Taking all of the above into consideration, the Panel determined that the Registrant’s fitness to practise remains impaired because of her lack of competence.
24. The Panel went on to consider what action to take today. The Panel took into account the HCPC’s Indicative Sanctions Policy document and considered its powers under Article 30(1). 
25. The Panel 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 and taking no action would neither protect the public nor be in the public interest.  
26. 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. 
27. The Panel next considered whether Conditions of Practice could be re-imposed whilst keeping the public safe. It took into account the following factors:
a) There had been considerable periods of supervision required from early on in the Registrant’s career as an ODP;
b) The Conditions of Practice Order was imposed on 14 May 2014 as that Panel considered that the Registrant was capable of developing insight and the knowledge and skills necessary for safe independent practice;
c) The Panel on the first review of 5 May 2015 found that the Registrant had not developed any insight into the extent of her shortcomings that would help her become a safe practitioner, and she was suspended.
28. Despite the above factors, the Registrant has not gained insight into the lack of competence found proved against her, nor has there been any improvement in the Registrant’s current ability to practise safely as an ODP.
29. In the light of the above, the Panel determined that a Conditions of Practice Order would not be sufficient to protect the public and/or the public interest.
30. The Panel then considered whether a Suspension Order was the appropriate and proportionate response to the risk to the public and the public interest identified. It determined that in the light of all of the above considerations, the least restrictive sanction is that of a Suspension Order for 12 months. The Panel exercises its powers under Article 30(1) of the Health and Social Work Professions Order 2001 and imposes this 12 month Suspension Order upon the expiry of the current order.

Order

The Registrar is directed to suspend the registration of Mrs Joy Lytham for a further period of 12 months on the expiry of the existing Order.
 
The order imposed today will apply upon the expiry of the current order.
 
This order will be reviewed again before its expiry.

Notes

This Conduct and Competence Committee Substantive Review Hearing took place at HCPC London on Tuesday 12 July 2016.

Hearing History

History of Hearings for Mrs Joy Lytham

Date Panel Hearing type Outcomes / Status
26/06/2017 Conduct and Competence Committee Final Hearing Voluntary Removal agreed
12/07/2016 Conduct and Competence Committee Review Hearing Suspended
06/05/2016 Conduct and Competence Committee Review Hearing Suspended
05/05/2015 Conduct and Competence Committee Review Hearing Suspended