Mr John F Skelton
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During the course of your employment as an Orthotist at University Hospitals Bristol NHS Foundation Trust from around March 2014 until around March 2015 you:
1. In relation to Service User A:
a) On or around 8 August 2014 you:
i. Did not consistently use professional communication
ii. You did not appropriately accommodate Service User A’s wishes
2. In relation to Service User B, who has cerebal palsy:
a) On or around 8 August 2014 you:
i. Said ‘‘you don’t have a disability,’’ or words to that effect
ii. Said Colleague A ‘‘was talking a load nonsense,’’ or words to that effect
iii. [Not proved]
iv. [Not proved]
3. In relation to Service User C:
a) Used unprofessional and or/inappropriate language including:
i. ‘‘if you were my private patient, I would not be treating you’’, or words to that effect
ii. ‘‘you don’t need splints’’ or words to that effect
iii. ‘‘she will want to wear high heels and by fitting her with splints you are not allowing her to do that,’’ or words to that effect
b) Did not appear to accommodate the wishes of Service User D, Service User C’s mother, in providing treatment to Service User C
4. In relation to Service User E:
a) On an unknown date before 26 February 2015 you:
i. Spoke to Service User E in an inappropriate manner
ii. Attempted to put Service User E’s foot into a splint that was not appropriate on more than one occasion
iii. Said her pain ‘‘was psychosomatic,’’ or words to that effect
iv. Said ‘‘why don’t you cut your leg off,’’ or words to that effect
b) On or around 26 February 2015 you:
i. Repeatedly called her by her last name
ii. Said ‘‘I am calling you by your last name, as you refused to be seen by me,’’ or words to that effect.
5. [Not proved]
6. On an unknown date you called Colleague B ‘‘petunia’’
a) The comment referred to in 6 was said in front of Service Users.
7. On an unknown date in the workplace, without reasonable excuse, you used racist and/or inappropriate terminology including:
b) ‘Chocolate Tart’
d) [Not proved]
8. The matters described in paragraphs 1-7 constitute misconduct.
9. By reason of that misconduct your fitness to practise is impaired.
1. The Panel has been convened to undertake a review of a substantive suspension order.
2. The Registrant has attended this hearing.
3. At the time relevant to the HCPC’s allegations, the Registrant was employed as an Orthotist by University Hospitals Bristol NHS Foundation Trust (“the Trust”). His employment commenced in about September 2013 on a contract for a year which was subsequently extended by six months until the end of March 2015. In the event, the Registrant resigned from the employment before it would otherwise have ended.
4. A referral was made by the Trust which resulted in a Panel of the Investigating Committee determining that there was a case to answer in relation to the allegation that was put before a panel of the Conduct and Competence Committee at a substantive hearing held between 23 and 26 January 2017.
5. The details of the factual case that was found proved by the substantive hearing panel sufficiently appear from the particulars of the allegation set out at the head of this determination.
6. The Registrant attended the substantive hearing. The panel undertaking that hearing found that the facts found proved amounted to misconduct. That panel stated that the Registrant had chosen to behave in ways that he considered acceptable, despite attempts to educate him and complaints from patients. The panel stated that his behaviour had impacted adversely on a number of service users and colleagues. It had caused upset and confusion as well as undermining colleagues. In one instance he had caused pain when fitting a splint. Further, he had used language that should never have been used and which had caused significant offence.
7. The substantive hearing panel found that the misconduct it found was impairing the Registrant’s fitness to practise in January 2017. The Panel found that the shortcomings it identified were of a nature that it would be possible to remedy, although the process of remediation had not yet commenced in any meaningful way. That being the case, that panel found that there was a risk of repetition. There also remained concerns that other lapses might occur, particularly because the Registrant professed himself unable to judge which words are acceptable in the modern world, nor was he able fully to comprehend the manner in which professional differences of opinion should be tackled and resolved so as not to impact negatively on patients. The panel also found that a finding of impairment of fitness to practise was required to satisfy wider public interest concerns.
8. The sanction imposed by the substantive hearing panel was a suspension order for a period of 9 months. That panel determined that a suspension order was a necessary and proportionate response given the risk of repetition it had identified and the lack of insight the Registrant had shown. The panel stated that a period of suspension of 9 months would provide the Registrant with an opportunity to engage further with the fitness to practise process and to demonstrate insight into his misconduct. The substantive hearing panel did consider whether a striking-off order should have been made. Its decision on the issue was that at that stage it would not be proportionate as the Registrant should be given the opportunity to more fully demonstrate insight and remediation of his misconduct.
9. In paragraph 70 of its determination the substantive hearing panel offered the Registrant the following guidance:
“…… a future Panel reviewing this Order would be assisted by the following:
a) A reflective piece by the Registrant, concentrating on what led to his misconduct, how his actions impacted, or could have impacted, on service users, and colleagues and how he has changed his behaviour and remediated his misconduct;
b) Information about any employment he undertakes;
c) An indication of his future professional plans;
d) Evidence of the Registrant keeping his practice up to date and remediating his misconduct by undertaking relevant courses. The reviewing panel may be particularly assisted by evidence from courses that have involved interaction with and challenge by other individuals. He may find it helpful to approach a professional body or academic institution;
e) Up to date character and/or employment references from persons who are aware of these proceedings and who can report on his behaviours.”
10. The suspension order imposed for a period of 9 months on 26 January 2017, was reviewed by a different panel on 7 November 2017. The Registrant did not attend that review hearing, but he did send an email dated 3 November 2017 for the consideration of the panel conducting the review.
11. The earlier reviewing panel took the view that some of the contents of the Registrant’s email dated 3 November 2017 were disrespectful of his profession and the regulatory process. It noted that although he had stated in that email that he had truly reflected on his approach to “care and communicate with people”, he had added his opinion that the substantive hearing panel should “reflect on its own motivations, agendas and dare I say reporting the facts.” The reviewing Panel observed that the Registrant had not assisted it by providing information about his employment or indication of his future professional plans, and additionally he had not submitted any evidence that he had been keeping his practice up to date and remedying his misconduct by undertaking relevant courses. Nor were there any character and/or employment references. The panel expressed the view that the Registrant was continuing to fail to take responsibility for his own practice and conduct and seemed to be unaware of his on-going responsibility to keep up to date with current training and evidence-based practice. The conclusion of the Panel was that the Registrant’s fitness to practice remained impaired as at the time of the review hearing in November 2017.
12. The sanction decided upon by the earlier reviewing panel was the imposition of a further order of suspension, on that occasion for a period of 6 months. The panel decided that such an order would, “provide the Registrant with a final opportunity to demonstrate commitment to his profession and the standards that underpin it.” That panel renewed the advice to the registrant (quoted in paragraph 9 above) that had been given by the substantive hearing panel as to the material that would assist a reviewing panel.
13. At the present review the Presenting Officer submitted that it was evident that the Registrant had not fully reflected on the matters found by the substantive hearing panel. She submitted that the Registrant’s fitness to practise was still impaired and that at the present time the appropriate sanction is a striking-off order.
14. Before the hearing commenced the Panel was provided with an email sent to the HCPC by the Registrant dated 26 April 2018 and a character reference contained in an email dated 27 April 2018. The Registrant’s email dated 26 April 2018 largely consisted of a re-sending of the email dated 3 November 2017 sent in advance of the first review.
15. During the present hearing the Registrant addressed the Panel. The substance of what he said will be referred to in the Panel’s decision on impairment of fitness to practice.
16. In undertaking the present review, the Panel is required to accept the findings of fact made by the Panel that conducted the substantive hearing, as well as the decision that the facts found to be proved amounted to misconduct. The findings that have been made hitherto about impairment of fitness to practise and as to sanction are part of the background to the case, but do not determine the issues to be decided by the present Panel.
17. The present Panel is required to decide if the findings made by the substantive hearing Panel in January 2017 are still impairing the Registrant’s fitness to practise. If the answer to that initial question is that there is no on-going impairment of fitness to practise, then there can be no question of a further sanction being imposed when the present period of suspension ends on 23 May 2018. If, on the other hand, the Panel concludes that there is continuing impairment of fitness to practise, then the Panel must consider the imposition of a further sanction upon the expiry of the present period of suspension. Any such consideration of sanction would involve the usual sanction considerations and require the Panel to have regard to the HCPC’s Indicative Sanctions Policy. Accordingly, a sanction should not be imposed to punish the Registrant, but be the least restrictive outcome consistent with the factors that had resulted in the Panel finding the on-going impairment of fitness to practise.
18. When the Panel decided whether the Registrant’s fitness to practise is still impaired, it paid close attention to what he said during the present hearing. He demonstrated an intractable attitude towards the matters that had been found against him in January 2017. He said that the offensive terms he had used were “deemed to be inappropriate”, stating that he had not intended to be offensive when using them. At no time did he acknowledge that people did, or even might, have found them offensive. Indeed, at one stage during the hearing he said, “people want to find offence in certain words”. He considered that it was sufficient that the Panel should accept his word that he learnt from the experience, stating that he did not wish to write a story of how he felt, apparently missing the point that the purpose of the reflective piece that had been suggested was that he should describe how his behaviour had made others feel and what steps he could or had taken to remedy it. He had made no efforts towards remediation of any aspect of the substantive panel’s findings, which included clinical issues as well as behavioural shortcomings. He stated that he considered the original panel’s decision amounted to punishment, stating that taking him away from practice had isolated him from his professional work.
19. The conclusion of the Panel was that the Registrant had hardly moved forward since the substantive hearing. The risk of repetition of unacceptable behaviour is as great now as it was at that time, and his fitness to practice is as impaired as it was determined to be by the substantive hearing panel. A finding of impairment of fitness to practise was necessary in respect of both the personal and public components relevant to that issue.
20. It followed from the finding that the Registrant’s fitness to practise is still impaired that the Panel had to consider the issue of sanction. The Panel applied the principles already described, and started with the least restrictive sanction. However, for the reasons articulated by both the substantive hearing panel and the first review panel, a sanction that would permit the Registrant to return to practise, even with restrictions, was inappropriate. This was because members of the public should not be exposed to the risk of a repetition of unacceptable behaviour that is the consequence of the failure to evidence remediation of the identified shortcomings.
21. It followed that the realistic sanction choice was between a yet further period of suspension and the making of a striking-off order. If the Panel considered that there was a willingness on the part of the Registrant to engage in a constructive manner to demonstrate remediation, the Panel would have made a further suspension order despite the opportunities that have been offered to him to date. However, the Panel has concluded that the Registrant has demonstrated clear resistance to taking proactive steps to demonstrate a willingness to address matters. Having been recommended by panels on two occasions as to the nature of evidence that might be helpful to him when reviews are undertaken, the only evidence tendered was an emailed testimonial from someone with whom he studied over 30 years ago. The testimonial was sought this morning and requested a reply “if possible” before the time at which the hearing was scheduled to commence. The Registrant’s attitude towards the suggested reflective piece has already been referred to. In the judgement of the Panel it was noteworthy that during a dialogue with the Panel Chair, during which she drew to the Registrant’s attention the absence of supporting evidence and why it was unsatisfactory for a panel to rely on a registrant’s own assessment of the extent to which they have addressed shortcomings, there was no suggestion by the Registrant that he acknowledged what he was being told and would wish to submit fuller evidence.
22. The making of a further suspension order would protect the public. However, in circumstances where the Registrant has failed to address matters in a meaningful manner and has shown no intention of doing so in the future, the Panel has concluded that a further period of suspension is not appropriate because the position at the end of it would be exactly as it was in January 2017, November 2017 and at the present time. Accordingly, the Panel has decided that the appropriate sanction to be imposed upon the expiry of the present period of suspension is a striking-off order. The Panel is satisfied that this is a proportionate response given the unwillingness of the Registrant to resolve matters.
Order: Upon the expiry of the current period of suspension, namely with effect from 23 May 2018, the Registrar is directed to strike the name of John F Skelton from the Register
The Order imposed will take effect on 23 May 2018 when the current Suspension Order expires.
History of Hearings for Mr John F Skelton
|Date||Panel||Hearing type||Outcomes / Status|
|27/04/2018||Conduct and Competence Committee||Review Hearing||Struck off|
|07/11/2017||Conduct and Competence Committee||Review Hearing||Suspended|