Ruth E Yorkston

Profession: Occupational therapist

Registration Number: OT32791

Interim Order: Imposed on 18 Apr 2017

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 18/04/2017 End: 16:00 19/04/2017

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation as amended:

During the course of your employment as an Occupational Therapist for Tees,
Esk and Wear Valleys NHS Foundation Trust between April 2010 and
February 2012, you:

1. Did not demonstrate adequate clinical reasoning and/or skills in that you:

 a) Were unable to demonstrate an adequate understanding of the  MOHOST tool and/or its rating system.

 b) Were unable to demonstrate an adequate understanding of the  Mayers Lifestyle Questionnaire.

c) In relation to Case 1:

i) You did not specify height measurements in relation to a bath,   toilet and/or bed;

ii) You did not provide any/or adequate indication of whether the   heights referred to at 1c)i) might pose a problem for the Service   User post-surgery;

iii) You did not contact the acute hospital about any help they   could provide the Service User following her planned surgery.

d) In relation to Case 3, on 25 October 2011 recorded a plan to visit the
 Service User for food shopping on 2 November 2011 but did not state  why you had selected this activity in the notes.

e) In relation to Case 4, on or around 25 October 2011 you made an  entry in the notes which was fragmented and/or did not make sense.

f) In relation to Case 5:

i) Your entry dated 19 October 2011 was unclear, in that it did   not specify what further assessment was to be undertaken;

ii) On 1 November 2011, the information you recorded in relation   to a cooking assessment of the Service User did not state how   he managed the process and/or whether he was able to    continue cooking for himself;

iii) Your entry relating to contact which took place on 9    November 2011 was unclear and/or fragmented.

g) In relation to Case 8:

i) Following a home visit on 25 November 2011 you noted that   the Service User wanted to have his teeth removed but did not   take any/any adequate steps to clarify whether this was a    genuine need or a possible symptom of his mental health;

ii) Your plan, recorded following a home visit on 25 November   2011, did not adequately address the Service User’s needs.

h) In relation to an OT assessment you observed on 6 October 2011  you produced a reflective log but did not include all relevant  information.

i) In relation to an OT assessment you observed on 19 October   2011 you produced a reflective log which did not include all    relevant information.

2. Did not complete follow-up actions in that:

a) In relation to Case 1, you did not contact and/or did not adequately  record your contact with the Service User's Care Coordinator as  planned:

i) following a telephone conversation with the Service User on 3   November 2011;

ii) following a home visit to the Service User on 8 November    2011;

iii) until prompted in supervision on 17 November 2011.

b) In relation to Case 1, you did not make and/or record appropriate  enquiries into the Service User’s potential vulnerability on:

i) 3 November 2011;

ii) 8 November 2011.

c) In relation to Case 2, having recorded a plan on 24 November 2011  to speak to the Service User’s Care Coordinator you:

i) did not contact and/or adequately record contacting the Care   Coordinator in a timely manner;

ii) did not inform and/or record informing the Care Coordinator of   a potential risk to the Service User, in that a person who    answered the phone indicated that he “did not live there” or    words to that effect.

d) In relation to Case 8, following information being provided to you  during an assessment on 28 November 2011 as to the Service User’s incontinence, you did not make a referral to an incontinence nurse in a  timely manner or at all.

3. Did not maintain adequate records in that:

a) In relation to Case 1, in an entry dated 8 November 2011, you:

i) referred to yourself both as ‘therapist’ and as ‘Occupational   Therapist’;

ii) made reference to a telephone call but did not state when it   occurred;

iii) your entries made on 3 November 2011 and 8 November    2011 were unclear such that they required subsequent  amendments.

 b) You made amendments to records after entries had been  countersigned by your clinical supervisor, in that you:

i) In relation to Case 1, made amendments to an entry dated 17   November 2011;

ii) In relation to Case 5, made amendments to an entry dated 2   November 2011.

c) Did not record the following relevant information:

i) In relation to Case 1, a telephone conversation between you   and the Service User which took place on 8 November 2011;

ii) In relation to Case 3, the outcome of the OCAIRs and/or    Mayers Lifestyle Questionnaire completed on 25 October 2011   within the case entry;

iii) In relation to Case 8, your entry following the home visit on   25 November 2011 was blank in respect of Objective 3.

d) In relation to case 7:

i) on or around 8 December 2011, did not record sufficient    information to identify the level of risk arising from the Service   User’s failure to take her medication;

ii) did not seek and/or record seeking advice from a consultant   or other suitable professional in relation to the Service User    missing her medication.

e) In relation to Case 8, on 25 November 2011 you conducted a home  visit and did not conduct and/or record a Mental State Examination  (MSE) despite being made aware that the Service User's father had  halved his medication the night before your visit.

f) In relation to Case 8, your entry following the home visit on 25  November 2011 did not record sufficient information to enable an  assessment to be made of the risk involved after being made  aware that the Service User’s father had halved his medication.

4. Did not complete an adequate report in that, in relation to Case 3, the
Occupational Therapy Functional Assessment report completed between 11
and 16 November 2011:

a) Contained unnecessary repetition;

b) Recorded information in the wrong sections;

c) Did not include observations on the Service User's abilities and/or functioning during the shopping trip.

5. Did not complete tasks in a timely manner in that:

 a) In relation to Case 5, a cooking assessment took place on 1  November 2011 but your report was not completed until 24 November  2011;

 b) In relation to Case 3:

i) You had not completed an entry on PARIS for a community   assessment made on 2 November 2011 by 9 November 2011;

ii) You had not completed an Intervention Plan by 17 November   2011, despite having been instructed to complete this on 9    November 2011.

c) In relation to Case 7, on 14 December 2011 you had not recorded  an assessment and/or completed an intervention plan when the original  deadline for completion was 6 December 2011.

d) In relation to Case 8:

i) By 12 December 2011, you had not seen the Service User    despite having planned to see him the week of 5 December    2011;

ii) By 12 December 2011, you had not completed an intervention   plan when the original deadline for completion was 5 December   2011.

6. The matters set out in paragraphs 1 - 5 constitute misconduct and/or lack
of competence.

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


Preliminary matters

1. Mr Orpin-Massey made an unopposed application to amend particulars 2(b)(i) and 3(f) of the particulars of the allegation. The Panel granted the application on the grounds that the proposed amendments were minor in nature, clarified the particulars and caused no injustice to the Registrant. The particulars as amended are set out above.


2. The Registrant is an Occupational Therapist. She qualified in 1992 and worked for Tees, Esk and Wear Valleys NHS Foundation Trust as an Occupational Therapist from 2001 until 2012.

3. In 2008 concerns arose relating to her ability to perform her job adequately. These concerns persisted throughout 2008 and into 2009. In about November 2009 the Trust received an Occupational Health report, which outlined that the Registrant suffered from a health condition. In light of this health concern it was decided to redeploy her to a different team. The team to which she was moved was the South Durham Psychosis Team, based at the Goodall Centre. She moved to this team on 1 April 2010.

4. On 27 July 2010 it was reported that there were continuing concerns about the Registrant’s competence, she was therefore removed from clinical practice on 05 August 2010 and placed within the inpatient Occupational Therapy Team to complete project work not involving patient contact. An investigation was initiated into the Registrant’s clinical practice.

5. In July 2011, MB, Professional Head of Allied Health Professionals with the Trust, was asked to produce an action plan to support the Registrant’s clinical reasoning, practice, and record keeping, with a view to returning her to supervised practice. The plan contained 12 objectives. The Registrant was to be based in the Darlington Psychosis Team (also known as the Woodland Road Team) for three months to receive support and build up her caseload to a maximum of 15 cases. Other objectives were for her to provide clear evidence of understanding and applying Occupational Therapy processes and to use the Mayers Lifestyle Questionnaire (MLQ) tool and Model of Human Occupational Screening Tool (MOHOST). These tools were used by Occupational Therapists to identify a service user’s occupational needs and to understand their engagement in activities of daily living. Her placement was to be supervised by BL, Specialist Occupational Therapist. The Registrant was restricted to working on 5 or 6 cases and any work she did was to be supported by formal weekly supervision, and informal daily supervision by BL. The Registrant transferred to the Darlington Psychosis Team 10 October 2011.

6. The Registrant’s duties involved recording her observations of service users on PARIS, the Trust’s electronic database for patient case records in the health care setting.

7. The action plan was formally reviewed in both November and December 2011. On 12 December the Registrant’s placement with the Darlington team was terminated owing to concerns about her practice and service user safety. The concerns were collectively referred to a Disciplinary hearing, which took place on 03 April 2012.

8. The Registrant self-referred the concerns about her practice to the HCPC in June 2012. That referral eventually resulted in the current proceedings.
9. In summary, it is alleged that between October 2011 and December 2011 the Registrant did not demonstrate adequate clinical reasoning and/or skills, that she was unable to demonstrate an adequate understanding or ability to use the observation and assessment tools referred to above and that she failed to produce reflection pieces that included all relevant information or demonstrated adequate clinical reasoning and/or skills.

Facts proved

10. The Panel was provided by the HCPC with a bundle of documents comprising the witness statements of BL, MB and TT and the various supporting documents, in particular service user records, which they exhibited. The Panel also received a witness statement from the Registrant. The Panel read and had regard to all these documents.

11. At the outset of the hearing the Registrant admitted the following particulars of the allegation, namely: 1(f)(i), 2(b)(i), 2(b)(ii), 2(c)(i), 2(c)(ii), 2(d), 3(a)(i), 3(a)(ii), 3(a)(iii), 3(b)(i), 3(b)(ii), 3(c)(ii), 3(c)(iii), 3(d)(i), 4(a), 4(b), 4(c), 5(a), 5(b)(i), 5(b)(ii), 5(c), 5(d)(i), and 5(d)(ii).

12. The Panel was mindful that the burden of proof is on the HCPC and that the civil standard of proof applies, so the particulars of the allegation must be proved on the balance of probabilities. The Panel took into account submissions by Counsel on behalf of the HCPC and the Registrant and accepted the advice of the Legal Assessor.

13. The Panel heard oral evidence on behalf of the HCPC from BL and MB, who confirmed the content of their witness statements and gave additional evidence in response to questions. In addition the Panel received as hearsay evidence the witness statement of TT, whose attendance was not required by either party. The Panel heard oral evidence from the Registrant who confirmed the content of her witness statement and gave additional evidence in response to questions.

14. The Panel found the evidence of BL to be credible and clear with a good recall of events. There was no evidence that he was in any way biased against the Registrant or that he had any agenda other than to support her to the best of his ability, which is what he did.

15. The Panel found MB’s evidence to be clear, knowledgeable and to the point. She was helpful, unbiased and not in any way defensive. She was the very model of a professional witness.

16. The Panel found the Registrant to be credible, honest and well-meaning. However, she had difficulty in understanding questions and issues and struggled in communicating her answers. Her evidence was often muddled and not always relevant, having a tendency to go off at a tangent.

Case 1
Particulars 1(c)(i)-(iii) Not proved

17. Service user 1 was referred to Occupational Therapy by her care coordinator to see how she could be assisted with Activities of Daily Living (ADL) prior to a planned hysterectomy. However, both BL and the Registrant gave evidence that the service user had not given her consent to undergo an assessment by an Occupational Therapist. In the circumstances the Panel was of the view that the Registrant could not be fairly criticised for failing to carry out a proper Occupational Therapy assessment. Further, in the absence of consent and a full assessment, it would not have been appropriate for the Registrant to contact the hospital about any help with which they could provide the service user after she had undergone surgery. Accordingly, the Panel found particulars 1(c)(i)-(iii) not proved.
Particulars 2(a)(i)-(iii) Proved
18.  In cross-examination, the Registrant accepted that she had to be prompted by BL in supervision on 17 December 2011 to contact the service user’s care coordinator. It follows that particulars 2(a)(i)-(iii) are proved.
Particulars 2(b)(i)-(ii) Proved

19. These particulars are proved by the Registrant’s own admissions.
Particulars 3(a)(i)-(iii) Proved

20. These particulars are proved by the Registrant’s own admissions.
Particular 3(b) Proved

21. This particular is proved by admission.

Case 2
Particular 2(c) Proved

22. This particular is proved by admission.

Case 3
Particular 1(d) Proved

23. This particular was denied by the Registrant. The Panel was satisfied on the basis of the service user notes for 25 October 2011 that the Registrant recorded a planned visit to the service user for food shopping on 02 November 2011 but did not state why she had done so. Particular 1(d) is therefore proved.

Particular 3(c)(ii) Proved
24. This particular is proved by admission.

Particulars 4(a)-(c) Proved
25. These particulars are proved by admission.

Particulars 5(b)(i)-(ii) Proved
26. These particulars are proved by admission.

Case 4
Particular 1(e) Proved

27. The Registrant did not admit this particular. The Panel considered the Registrant’s notes dated 25 October 2011 relating to this service user and agreed with the evidence of BL that the Registrant’s notes were fragmented and inconsequential. Accordingly, this particular is proved.

Case 5
Particular 1(f)(i) Proved

28. This particular is proved by admission.
Particular 1(f)(ii)-(iii)

29. The Registrant did not admit these particulars. The Panel considered the relevant notes made by the Registrant in relation to her visits to this this service user dated 01 and 09 November respectively and agreed with the evidence of BL that they were inadequate in the respects particularised.

Particular 3(b)(i) Proved
30. This particular is proved by admission.

Particular 5(a) Proved
31. This particular is proved by admission.

Case 7
Particular 3(d)(i) Proved

32. This particular is proved by admission.
Particular 3(d)(ii) Proved

33. The Registrant initially denied this particular but in the course of cross-examination admitted that she had probably not sought advice from a consultant or other medical practitioner concerning the risk to the service user in failing to take her medication. Accordingly, this particular is proved.
Particular 5(c) Proved

34. This particular is proved by admission.

Case 8
Particular 1(g)(i)-(ii) Proved

35. These particulars were denied by the Registrant. The Registrant recorded in her notes of a visit to this service user on 25 November 2011 that his father had halved his medication and also that the service user wished to visit a dentist to have all his teeth removed. The Registrant made no attempt to ascertain the reasons why the service user expressed a wish to have his teeth removed or to consider whether this might be related to his mental health and the fact that his medication had been halved. The Panel accepted the evidence of BL that the Registrant’s plan for the service user relating to this visit did not in any way address his needs.
Particular 3(c)(iii) Proved

36. This particular is proved by admission.
Particular 3(e)-(f) Proved

37. These particulars relate to the same home visit by the Registrant to the service user on 25 November 2011 and are found proved for the same reasons.

Particulars 5(d)(i)-(ii) Proved
38. These particulars are proved by admission.

Decision on Grounds

39. The Panel is aware that findings as to misconduct and lack of competence are matters for its professional judgement, in respect of which neither the burden nor the standard of proof applies.
40. The Panel took into account judicial guidance referred to by both Counsel in their written submissions as to the meaning of the terms misconduct and lack of competence.

41. The Panel found the Registrant to have been in breach of Standards 1, 5, 6, 7 and 10 of the HCPC’s Standards of Conduct, Performance and Ethics and Standards 1a, 1b, 2a, 2b and 3a of the HCPC’s Standards of Proficiency for Occupational Therapists.

42. In the Panel’s judgment none of the particulars amounted to misconduct but rather they constituted lack of competence. The Registrant was well-intentioned and wished to achieve the objectives set for her in the action plan but did not have the knowledge, skills, training or awareness to do her job properly. She either did not understand what was required of her or, if she did understand, she was unable to carry out her work to the required standard. As a result, her standard of professional performance fell far below the standards of proficiency to be expected of a reasonably competent Occupational Therapist in the circumstances.

Decision on Impairment

43. The Panel carefully considered the submissions on behalf of the HCPC and the Registrant and accepted the advice of the Legal Assessor.

44. In determining whether the Registrant’s fitness to practise is impaired, the Panel took into account both the ‘personal’ component and ‘public’ component. The personal component relates to the Registrant’s own practice as an Occupational Therapist, including any evidence of insight and remorse and efforts towards remediation. The ‘public’ component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the regulator.

45. The Panel found that the Registrant’s fitness to practise was and remains impaired having regard to the personal component. The particulars of the allegation, which the Panel has found proved, cover a broad range of failings relating to clinical reasoning and the recording of information. Whilst these failings are individually relatively minor, they cumulatively amount to a real risk to service users. The Registrant appears to have limited insight, in that she sought to pass responsibility onto other colleagues, on computer problems and lack of training, whilst failing to acknowledge her own primary responsibility to be accountable for her practice as an autonomous practitioner. There is no evidence before the Panel that the Registrant has remediated her practice since the date of these incidents and indeed she has not practised as an Occupational Therapist since 2011.

46. The Panel also found the public component of impairment to be satisfied in this case. The Registrant’s lack of competence poses a risk to service users, as a result of which public confidence in the profession and in the regulator would be undermined if there no finding of impairment.

Transfer to the Health Committee

47. In the Panel’s judgment, proper medical evidence is required for the further determination of this case. The Panel carefully considered the HCPC’s Practice Notice on Health Allegations and decided that this matter would be better dealt with by the Health Committee. Accordingly the Panel has decided to refer the allegation to the Health Committee for consideration pursuant to Rule 4 of the Health and Care     Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003.

Interim Order application

48. Mr Orpin-Massey applied for an interim suspension order under Article 31 of the 2001 Order on the grounds that such an order is necessary for the protection of the public or is otherwise in the public interest. Ms Hayden opposed on the application on the grounds that there is no likelihood that the Registrant will return to practise as an Occupational Therapist until these proceedings have been finally determined. The Panel took into account the fact that the Registrant has not practised as an Occupational Therapist since 2011 and that she would have to disclose to any prospective employer that she remains subject to these proceedings and that there is a finding that her fitness to practise is impaired. In all the circumstances, the Panel considered there is no real risk that she will return to practise as an Occupational Therapist until these proceedings have been determined. Accordingly, an interim order is not necessary for public protection or the wider public interest and the application is refused.

Preliminary Matters

49. On 18 April 2017 the hearing resumed.  At the outset of the hearing Mr Orpin-Massey, on behalf of the HCPC, outlined the legal framework for referral to the Health Committee. In his opening he explained that at the time the Panel purported to refer the matter to the Health Committee, it did not have the power to do so, as it was no longer ‘considering an allegation’ for the purposes of Rule 4 of the Conduct and Competence Rules. The Panel had already determined the allegation when it made findings of fact and concluded that the Registrant’s fitness to practise is impaired on the grounds of lack of competence.
50. As a consequence, the Panel remains seized of the case and proceeded to consider the issue of sanction.

Assessment of Witnesses

The Registrant

51. The Registrant chose to give evidence again. She described the difficulties she experienced whilst working at the Trust following a restructuring of the division in July 2008 which resulted in her moving to a new team. The Registrant informed the Panel that her stress was exacerbated when another Occupational Therapist left and as a consequence the Registrant’s caseload was increased. The Registrant also confirmed that she continues to be prescribed medication by her GP for her lifelong conditions.  The Registrant informed the Panel that she would like to return to work as an Occupational Therapist.

52. The Panel recognised that giving evidence is a stressful event and took this factor into account. However, the Panel concluded that the Registrant failed to demonstrate that she had taken the opportunity to develop meaningful insight into her level of competence and how to address these shortcomings now and in the future. In particular the Registrant focused on blaming others for what she perceived to be unfair treatment rather than address the wide-ranging deficiencies in her practice. Even when prompted the Registrant appeared unable or unwilling to articulate where she had gone wrong and the steps she had taken to address the deficiencies in her skills and knowledge and how to manage her lifelong medical conditions.

53. The Panel noted that the Registrant had taken steps to understand the MOHOST system but stated that she required training to be able to translate the theory into practice. However, the nature and extent of the Registrant’s shortcomings were much wider than her lack of understanding of MOHOST and the CPD courses that she had attended did not specifically address the areas where she lacked competence. Furthermore, attending courses alone is not sufficient to demonstrate remediation or progress towards remediation. It is the learning that has been acquired that is most important and the Registrant was unable to demonstrate that she is any further forward in acquiring the skills and knowledge required to competently perform the role of an Occupational Therapist.

Dr S

54. Dr S gave evidence on behalf of the Registrant. Dr S confirmed during her oral evidence that she prepared a report for the Trust’s internal appeal hearing and acted as the Registrant’s advocate during that hearing.

55. The Panel noted that for the purposes of this hearing Dr S was not an expert witness. Although the Panel accepted that Dr S meant well she was not independent and as a consequence the Panel were only able to place little weight on the opinions she expressed.

Decision on sanction

Panel’s Approach

56. The Panel accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of any sanction is not to punish the Registrant, but to protect the public and the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator and upholding proper standards of conduct and behaviour. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.

57. The Panel had regard to its findings in relation to lack of competence and impairment of the Registrant’s fitness to practise. The Panel also took into account the Indicative Sanctions Policy (ISP), the oral evidence of the Registrant and Dr Steffert and the submissions made by both parties.


58. In determining the appropriate sanction, if any, to impose the Panel first identified what it considered to be the mitigating and aggravating features of the case. The Panel identified the following mitigating factors:

• Previous unblemished career until 2008;
• There are no other regulatory findings against the Registrant.
The Panel identified the following aggravating factors:
• There is no evidence that the Registrant has any insight into her lack of competence;
• There is a high risk of repetition;
• The Registrant continues to blame others rather than accept personal responsibility;
• Limited evidence that the Registrant has made a concerted effort to address her lack of competence.

59. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s lack of competence to take no action on her registration would be wholly inappropriate. Furthermore, in the absence of exceptional circumstances the Panel concluded that taking no action would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

60. The Panel then considered a Caution Order.  The Panel noted paragraph 22 of the ISP which states:

“A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate action.  A caution order should also be considered in cases where the nature of the allegation means that meaningful practice restrictions cannot be imposed but where the registrant has shown insight, the conduct concerned is out of character, the risk of repetition is low and thus suspension from practice would be disproportionate.  A caution order is unlikely to be appropriate in cases where the registrant lacks insight.”

61. In view of the Panel’s findings that the Registrant has demonstrated no insight, when she had the opportunity to do so, the Panel concluded that a Caution Order was not appropriate. The Panel also took the view that the Registrant’s lack of competence could not be described as limited or minor in nature. The Panel noted that a Caution Order would impose no restriction on the Registrant’s practice and therefore concluded that it would not provide any protection from the risk of repetition. In these circumstances a Caution Order would fall well short of meeting the wider public interest in terms of declaring and upholding proper standards or maintain public confidence in the profession.

62. The Panel went on to consider a Conditions of Practice Order. The Panel noted that the ISP states at paragraph 25:

‘Before imposing conditions a Panel should be satisfied that:
• the issues which the conditions seek to address are capable of correction;
• there is no persistent or general failure which would prevent the registrant from doing so;
• appropriate, realistic and verifiable conditions can be formulated;
• the registrant can be expected to comply with them; and
• a reviewing Panel will be able to determine whether those conditions have or are being met.’

63. Although the Panel recognised that the Registrant’s lack of competence is capable of remediation, the Panel concluded that a Conditions of Practice Order was not workable for two reasons. First, the Registrant has not worked since 2014 and has not worked as an Occupational Therapist since December 2011. Having been out of practice for more than five years the Panel was not satisfied that the Registrant’s skills and knowledge were at the level that she could return to work without posing a risk of harm to service users. As a consequence any conditions would have to be so tightly construed that they would be tantamount to suspension. Second, even if the Registrant was able to return to work the Panel could have no confidence that the Registrant would comply with the terms of such an order. The Panel noted that concerns regarding the Registrant’s competence were raised from 2008 onwards resulting in an action plan being put in place in 2011. The action plan was formally reviewed in November 2011 and December 2011 resulting in a termination of the Registrant’s placement due to concerns about her practice and the safety of service users. The Panel took the view that as the Registrant had persistently failed to make adequate progress despite the extensive support that was offered to her for a significant period of time, there was no realistic possibility that she would be able to comply with conditions of practice. Therefore, the Panel concluded that it would not be possible to formulate appropriate conditions.

64. Furthermore, the Registrant’s persistent lack of competence and her inability or unwillingness to address the deficiencies in her skills and knowledge has the potential to undermine the trust and confidence the public are entitled to expect from all registered Occupational Therapists. As a consequence the Panel concluded that conditions would not adequately meet the wider public interest.

65. The Panel, having concluded that a Conditions of Practice Order would not be workable or sufficient to meet the wider public interest, determined that the Registrant should be made subject to a Suspension Order.

66. A Suspension Order would prevent the Registrant from practising during the suspension period, which would therefore provide temporary protection to the public and the wider public interest. The Panel concluded that during the intervening period the Registrant should take the opportunity to consider carefully the decision of this Panel and open her mind to the fact that her lack of competence persisted for a significant period and that a concerted effort will be required to remediate the deficiencies in her skills and knowledge. Furthermore, the Registrant will have to accept and properly reflect on the Panel’s findings if she is to begin the process of developing meaningful insight.

67. The Panel considered that in the absence of any progress in the 12 months since the finding of impairment was made in April 2016 it did not consider that any suspension period less than 12 months would be sufficient. Therefore, the Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period would be sufficient for the Registrant to demonstrate an appropriate level of insight into her failings and the appropriate steps she would need to take to practise safely and effectively. If she is unable to demonstrate insight within that time frame it is highly unlikely that she will ever be able to do so.

68. The Panel, in concluding that a 12 month Suspension Order is the appropriate and proportionate sanction, was satisfied that any lesser sanction would undermine public confidence in the profession. The Panel had regard to the impact a Suspension Order could have on the Registrant, but concluded that her interests were outweighed by the Panel’s duty to give priority to the significant public interest concerns raised by this case.

69. The 12 month Suspension Order will be reviewed shortly before expiry. This Panel cannot bind a future Panel, however, a future review panel may be assisted  by the following:

• Details of how the Registrant has kept her skills and knowledge up to date during the period that she has not been working as an Occupational Therapist.
• Evidence of the learning the Registrant has acquired.
• Evidence to demonstrate that the Registrant has developed appropriate coping strategies to deal with work related stress that may impact on her health conditions.



The Registrar is directed to suspend the registration of Miss Ruth Elizabeth Yorkston for a period of 12 months from the date this order comes into effect.


An Interim Suspension Order was imposed to cover the appeal period.

Hearing History

History of Hearings for Ruth E Yorkston

Date Panel Hearing type Outcomes / Status
11/10/2019 Conduct and Competence Committee Review Hearing Struck off
17/04/2019 Conduct and Competence Committee Review Hearing Suspended
10/04/2018 Conduct and Competence Committee Review Hearing Suspended
18/04/2017 Conduct and Competence Committee Final Hearing Suspended