Miss Heidi Mulrain
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During the course of your employment as a Speech and Language Therapist with University Hospital Birmingham NHS Foundation Trust between April 2010 and October 2011 you:
1) You failed to reach a satisfactory level in competencies for a Band 5 Speech and Language Therapist, in areas such as:
a) Your assessment of dysphagia and/or dysphasia patients, which included:
i) On or around 20 October 2010, you did not fully assess Patient C before recommending therapeutic intervention for treatment of his dysphasia;
ii) On or around 29 November 2010 you inappropriately commenced an assessment of Patient D without first communicating with the patient’s community nurse.
b) Your treatment planning in respect of people with dysphagia and/or dysphasia.
c) Your treatment plans in respect of people with dysphagia and/or dysphasia, which included:
i) On or around 23 December 2010 you inappropriately recommended that Patient S be trialled on a soft moist diet;
ii) On or around 23 December 2010 you inappropriately recommended that Patient E be trialled on fluids.
2) You were unable to work independently and autonomously in that you required input from colleagues.
3) On or around 7 July 2010 you inappropriately suggested that Patient A, who had a severe neurological injury, be discharged as you believed the patient’s language skills were intact.
4) On or around 30 July 2010, you inappropriately attempted to carry out a Speech and Language Therapy assessment on Patient B who was in a severely compromised respiratory status.
5) The matters set out in 1 to 4 amount to a lack of competence.
6) By reason of that lack of competence, your fitness to practise is impaired.
1. The Panel was satisfied that the notice of hearing dated 6 December 2016 had been properly served on the Registrant within the 28 day period as required by the HCPC (Conduct and Competence Committee) (Procedure Rules) 2003 as amended (‘The Rules’).
2. The Panel was also satisfied that all reasonable steps had been taken to serve the notice of hearing on the Registrant for the purposes of Rule 11 of the Rules. In her letter to the HCPC dated 15 December 2016 the Registrant acknowledged receipt of the notice of hearing and stated that she would not be attending the hearing. She pointed out that she had written to the HCPC earlier in 2016 requesting information on voluntary removal from the Register and that this continued to be her wish. The HCPC informed the Registrant by email dated 3 January 2017 that certain administrative steps had to take place before an application for voluntary removal could be made and, as this has not happened, the review hearing had to proceed. The Registrant replied by email on 3 January 2017. She offered her apologies to the Panel for not attending, and regretted that it was now too late for the administrative steps to take place for voluntary removal.
3. In view of these matters, the Panel concluded that the Registrant deliberately chose not to attend the hearing. She requested no adjournment and there would be no purpose in adjourning the hearing today. Therefore, the Panel decided that it was fair to proceed in the absence of the Registrant.
4. The Registrant commenced employment with University Hospital Birmingham NHS Foundation Trust (‘the Trust’) as a Band 5 Speech and Language Therapist (‘SLT’) on 1 September 2009. She was based at Queen Elizabeth Hospital and Selly Oak Hospital.
5. Concerns relating to the Registrant were first documented in about April 2010 by the Registrant’s Line Manger, RL, a Band 8a SLT. In June 2010, concerns were again discussed informally. As a result, the Registrant was to receive informal supervision by colleagues who included CD, then a Band 6 SLT.
6. Further concerns regarding the Registrant’s practice were identified on 17 July 2010 and 30 July 2010. As a result, the Trust’s Head of Speech and Language Therapy, KR, became involved. The Registrant was subsequently placed under formal supervision. The Trust’s Poor Performance Management process was started later in 2010.
7. Between July 2010 and January 2011, the Registrant’s supervisors set various performance objectives for her to meet during supervision sessions and reviewed her practice which was largely directly supervised. As a result of an improvement in the Registrant’s performance, from January 2011 the Registrant worked independently but had to review cases with more senior colleagues. In March 2011, following feedback about the Registrant, Stage 1 of the Formal Performance Management process began.
8. Stage 2 of the Formal Performance process began in June 2011. A Poor Performance Summary Report dated July 2011 was produced for the purposes of a Stage 2 Review meeting. The report concluded that the Registrant continued to be unable to provide autonomous, safe, no-harm interventions as required of a Band 5 SLT and recommended that the Registrant be issued with a Stage 3 - Final Written Warning in respect of her performance. In addition, by email sent on 4 July 2011, a referral was made to the HCPC.
9. Stage 3 of the Trust’s Formal Performance Management process started in approximately August 2011 and the Registrant returned to some clinical work under observed practice. However, on 18 October 2011, the Registrant resigned from her post.
The Decision of the Original Panel
10. At the substantive hearing in January 2014 the Registrant was present and was represented. The original Panel heard and considered the oral and documentary evidence presented by the HCPC together with the oral evidence of the Registrant and other material submitted on her behalf.
11. That Panel concluded that the facts set out in allegations 2, 3 and 4 had been found proved. The facts set out in the other allegations were found not proved.
12. The original Panel concluded that the allegations found proved amounted to lack of competence and that the Registrant’s fitness to practise was thereby impaired.
13. The Panel concluded that an order was necessary for the protection of members of the public and in the wider public interest and that a Conditions of Practice Order for 12 months was the proportionate response. In coming to that conclusion, the Panel observed that:
· the matters found proved amounted to a serious lack of competence over a long period of time and had the potential of causing the patient harm.
· taking no action or mediation was not appropriate having regard to the gravity of the facts as found proved and the fact that they were repeated and committed over a lengthy period, a Caution Order was not proportionate or appropriate.
· the matters found proved in allegations 3 and 4 had largely been addressed but there remained some concerns as to the identification of issues in dysphasia.
· the main concern was whether the Registrant was safe to practise independently with dysphagic patients, the evidence being that she appeared to be unable to do so unless supervised. It appeared that the Registrant had the knowledge of what she should be doing but was not always carrying it out.
· a suspension order would be disproportionate and would not remedy the matters that had been found proved.
· a Conditions of Practice Order of 12 months would be the appropriate period within which the Registrant could show her competence in respect of the failings that had been found.
The Conditions of Practice imposed by the original Panel were as follows;
1. You must notify the HCPC promptly of any professional appointment you accept for which registration with the HCPC is required and provide the contact details of your employer.
2. You must not work with or manage swallowing or potential swallowing disorders in adults or children unless directly supervised by a Speech and Language Therapist of at least Band 6 or equivalent.
3. You must maintain a record of every case where you have undertaken work identified in condition 2 above which must be signed by your supervisor who must also comment on the standard of your performance.
4. You must provide a copy of these records to the HCPC on a three-monthly basis. The first report to be provided within 3 months of the Conditions of Practice Order taking effect or confirm there have been no such cases during that period.
5. Should you apply to work as a Speech Language Therapist 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).
14. With regard to a review hearing the original Panel stated that, “shortly before the end of the period there will be a review. At that review the Panel would be helped by all records produced during the period of the conditions, a report from the Registrant’s supervisor, any evidence of how she has kept up to date and appropriate testimonials”.
The First Review Hearing
15. The first review hearing took place on 13 January 2015. The Registrant attended the hearing but was not represented.
16. The Panel considered the submissions made by the Registrant together with her oral evidence and other material submitted by her. The Panel accepted that, as she had stated in her letter dated 21 November 2014, “…… I am working as a Communication Support Coordinator with the Stroke Association and am contracted to work there until the end of August 2015.This role does not require use of my HCPC registration and I have not engaged in any work treating or working with potential swallowing disorders”.
17. The Panel found that the Registrant’s fitness to practise remained impaired. In view of her oral evidence and the contents of her letter of 21 November 2014, the Registrant had not been able fully to remedy the failings in her practice which led to the substantive finding of lack of competence. In those circumstances some restriction on her registration remained necessary.
18. Having concluded that the Registrant’s fitness to practise remained impaired on the personal and public component, the first reviewing Panel concluded that a Conditions of Practice order for a further period of 2 years was a necessary, sufficient and proportionate sanction for protection of members of the public and was in the public interest.
19. The reviewing Panel decided that a period of 2 years was the appropriate time within which the Registrant would be able to demonstrate competence in respect of the failings found by the original Panel.
20. At that review it was suggested that the next reviewing Panel would be helped by;
· Supervisory records.
· Personal submissions showing how the concerns had been addressed.
· Evidence of CPD and reflective learning both with respect to the specific failings identified and her practice as a Speech and Language Therapist in general.
· Testimonials if appropriate.
Events since the First Review Hearing
21. In her letter dated 10 June 2015 the Registrant informed the HCPC that she had not engaged in any work since January 2015 which required HCPC registration. She had been working for the Stroke Association since May 2014. Her contract was due to finish at the end of August 2015. She stated that, ‘if anything needs to change with regards to my HCPC registration I will as promised let you know’.
22. In her letter dated 24 March 2016 the Registrant stated, -
‘I am writing regarding my HCPC renewal as well as a request to be removed from the register. As you are no doubt aware, I am undergoing an ongoing HCPC investigation into my competency to practice … I have now been out of practice and have [not] practised since 2011.
Since my last hearing, I have continued to work at the Stroke Association … I have liaised with various Speech and Language Therapists in the region and investigated whether I could do some voluntary work … to prove my competency … it has not been possible to secure voluntary employment. I have also contacted agencies but having explained the situation, I have … been unsuccessful.
I recognize that having been out of practice for longer than it took to train, I would no longer be safe to practise. This has not been an easy decision for me but I am asking now to be removed from the HCPC register. ….’
23. There appears to have been no response to this letter from the HCPC. The Registrant had written again, by email, to the HCPC dated 1 August 2016 stating -
‘I posted you the attached letter ... some months ago when my registration was due for renewal. I should have automatically been removed from the register and had some acknowledgement. … Can you please confirm how I get removed from the register …’
24. In her letter of 15 December 2016 the Registrant confirmed that she had not worked as a Speech and Language Therapist since 2011. She stated that, as she did not wish to work in an acute setting, this would mean that she would not meet the dysphagia competencies. She stated that she had ceased to maintain her CPD. She explained in detail the reasons why she no longer wished to continue as a registered practitioner and repeated her request for voluntary removal from the register.
25. The Panel has concluded that the Registrant’s fitness to practise remains impaired by the failings found by the original Panel. By her own admission, the Registrant has not remedied her shortcomings in the area of dysphagia, has ceased to maintain her CPD and has not worked in registered practice since 2011.
26. In deciding how to exercise its powers under Article 30(1) of the Health and Social Work Professions Order 2001, as amended, the Panel has taken into account the guidance in the HCPC’s Indicative Sanctions Policy. The Panel has taken into account the principles of proportionality, balancing the interest of the Registrant with the public interest.
27. Some restriction on the Registrant’s fitness to practise is necessary in view of the circumstances of the current impairment. Neither conditions of practice nor any lesser measure would provide a sufficient response. The Panel has concluded that in view of the matters to which it has referred as reasons for the Registrant’s continued impairment of fitness to practise, an order of suspension is necessary. The Panel was aware that it had the power to make a striking off order but considered that this would be too punitive a step particularly given the level of engagement by the Registrant and her repeated request for voluntary removal.
28. The Panel determined that the period of suspension should be one of 6 months. That period should be sufficient for the procedures relating to the voluntary removal of the Registrant from the register to take place.
This Order will apply from 14 February 2017.
History of Hearings for Miss Heidi Mulrain
|Date||Panel||Hearing type||Outcomes / Status|
|31/05/2017||Conduct and Competence Committee||Final Hearing||Voluntary Removal agreed|
|06/01/2017||Conduct and Competence Committee||Review Hearing||Suspended|