Mr Ian J Silkstone
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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;
(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.
Service of Notice
1 The notice of today’s hearing dated 8 March 2017 was sent to the Registrant by first class post on that date to his address as it appeared in the Register. The notice contained the date, time and venue of today’s hearing and was properly served on the Registrant within the time required by The Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”).
2 Accordingly the Panel was satisfied that the notice of hearing has been served in accordance with the Rules.
Proceeding in the Absence of the Registrant
3 The Panel then went on to consider whether to proceed in the absence of the Registrant.
4 Having heard submissions from Ms Bentley that it should do so, considered the Practice Note on Proceeding in Absence and having received advice from the Legal Assessor, the Panel decided to exercise its discretion under r.11 of the Rules to proceed with the hearing in the absence of the Registrant, for the following reasons.
5 The notice of hearing was properly served on the Registrant, who responded by an undated letter received by the HCPC on 11 April 2017 in which he stated, -
Re Hearing 12/4/17
I will not be attending the above dated hearing, nor will I be asking for an adjournment.
6 In those circumstances, there is no reason why the Registrant would attend the hearing if it were adjourned to a later date. There is no unfairness to the Registrant in proceeding today and there is a public interest in conducting this statutory review expeditiously, in view of the fact that the current order expires in May 2017.
7 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.
8 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 tried to assist parents with their enquiries and reviewed the relevant patient notes.
9 Upon review it was noticed that the Registrant had failed to write up patient notes, conduct patient assessments and formally record all Physiotherapy interventions with patients as required by the Chartered Society of Physiotherapy (CSP) Core Standards of Physiotherapy Practice.
10 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.
11 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.
12 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
13 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 and determined that those amounted to misconduct and a lack of competence. That Panel found the Registrant’s fitness to practise to be impaired and imposed a Conditions of Practice Order on the Registrant’s registration for a period of 12 months. In its decision at paragraph 84, the Panel stated that it had considered suspension but this would have been disproportionate in the circumstances and,
It would serve no purpose to deny the public .. the services of an experienced Registrant, if he were to return to practise with adequate safeguards as set out in the conditions of practice order.
The First Review Hearing
14 The case was first reviewed on 15 January 2016. The Registrant was neither present nor represented. However, he had sent an email to the HCPC asking for more time to obtain supervision and to demonstrate that he was able to, and had, fulfilled the conditions imposed on his registration.
15 The reviewing Panel determined that the Registrant’s fitness to practise remained impaired as there had been no relevant change in circumstances since the substantive hearing.
16 That Panel stated that it recognized that Mr Silkstone had tried to obtain supervision but that he had not been successful so far. In the light of this, the Panel accepted that the Registrant was still committed to remaining in the profession.
17 That reviewing Panel decided that the appropriate action was to further extend the conditions of practice order by 15 months and it varied two of the conditions.
18 The Panel stated that it had considered making an order for suspension but this would be disproportionate, taking into account in particular the Registrant’s engagement with the process.
19 The conditions as varied were 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 the objectives contained in your Personal Development Plan.
20 By letter to the Registrant dated 4 October 2016 which enclosed a copy of the decision of the first reviewing Panel, the HCPC set out the conditions imposed and stated that the next reviewing Panel would have the full range of sanctions available to it at the time of the original hearing. A letter dated 30 October 2017 containing notification to similar effect was also sent to the Registrant. A further letter dated 16 March 2017 containing a similar warning was sent to the Registrant and the notice of hearing (of 8 March 2017) made specific reference to the possibility of a striking off order being made.
21 In his letter received by the HCPC on 11 April 2017, the Registrant further stated as follows, -
I have no evidence to offer that I have met the requirements to remain registered as a physiotherapist. I will not offer any evidence that I have met the conditions of practice placed upon myself at the FTP hearing of 26/1/15.
I appreciate that I will be removed from the HCPC Register, but I have no intention of practicing [sic] again.
22 The Panel considered first whether the Registrant’s fitness to practise remains impaired. The Panel noted;
1. The multiple failures identified by the original panel
2. While the Registrant showed some insight he nevertheless tended to blame others for some of his failings.
3. Only some of the facts found proven were admitted.
4. No evidence of remediation or attempted remediation has been placed before the Panel.
23 The Panel is unaware of whether any and if so what steps have been taken by the Registrant to attempt to find work as a registered Physiotherapist so as to engage the current conditions of practice. However, even without working as a Physiotherapist, the Registrant could have provided the information set out in the first and third bullet points of condition numbered 5, that is to say a CPD folder demonstrating reflective practice and relevant and up-to-date clinical knowledge. Therefore, the Registrant’s fitness to practise continues to be impaired.
24 Ms Bentley submitted that in the circumstances a sanction of suspension or erasure would be appropriate in this case. The Legal Assessor referred the Panel to the recent case of Clarke v GOC  EWHC 521 (Admin) in particular.
25 In making its decision on the issue of sanction generally and the issue of risk to the public in particular, the Panel has taken into account all relevant factors and borne in mind the guidance set out in the HCPC’s Indicative Sanctions Policy.
26 The Registrant has indicated that he has no intention of continuing to practise. However, that intention could change and a Physiotherapist does not need equipment to practise. Importantly, in Clarke v GOC the optometrist had admitted the allegations before the original fitness to practise hearing, had sold his practice and business and had retired as an optometrist. In the current case, the Panel is not persuaded that there is no risk of repetition simply because of the statement in the Registrant’s most recent letter. He has previously stated that he was committed to the profession and has now changed his mind. He could also change it again and would need no special equipment in order to practice.
27 In deciding on the appropriate course of action, the Panel first considered whether no action would be an appropriate response to the continuing impairment. However, this would leave the public and service users in particular unprotected against the risk of unsafe practice by the Registrant, were he to decide to work as a Physiotherapist and would not adequately mark the public interest requirements.
28 For the same reason, both mediation and a caution order would be inappropriate.
29 The Panel next considered whether a further period of conditional registration would meet the demands of the case. Conditions are appropriate where a registrant is likely to comply with practice restrictions imposed with a view to a return to safe and effective practice. Orders of conditional registration for a total period of 27 months have been imposed but have achieved nothing. The Panel has no evidence that the Registrant has kept his learning and skills up-to-date, as he could have done by taking the steps specified in the first and third bullet points of condition 5. He has provided no evidence to indicate that he has taken any steps to put himself in a position of being able to take the steps set out in the remainder of the conditions. Therefore, conditional registration would no longer be a suitable response.
30 A period of suspension would provide public protection. The Registrant has shown no willingness since the last hearing to remedy the serious deficiencies in his practice. In those circumstances, the Panel has considered that the effect on the Registrant of a suspension order would be no different to a striking off order, save in one respect. It is true that the reputational effects of a striking off order are greater than an order of suspension.
31 However, an important factor to bear in mind is the efficient functioning of the regulatory process. There is no justification for repeated hearings, if there is ultimately no purpose to them. In addition, the Registrant was well aware that a striking off order could be made at this hearing in view of the correspondence sent to him in 2016 and shortly before this hearing. Despite those letters, he decided to offer no evidence of remediation and accepted that a striking off would be the likely result today. Although the original Panel considered that even an order of suspension would be disproportionate, the circumstances have changed significantly since that time. The Registrant has had the opportunity to remediate his failings. There is no evidence he has done so. In all the circumstances an order of suspension would not be appropriate.
32 Therefore, the Panel has decided that the only appropriate sanction is that of striking off.
ORDER: That the Registrar is directed to strike the name of Ian J Silkstone from the Register on the date this order comes into effect.
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|