Mr Robert David Linton

Profession: Social worker

Registration Number: SW34434

Hearing Type: Final Hearing

Date and Time of hearing: 09:00 11/04/2018 End: 16:00 13/04/2018

Location: Health and Care Professions Tribunal Service (HCPTS), 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

(as amended at the final hearing)

During the course of your employment as a Social Worker at Newcastle City Council between April 2015 and 30 June 2016:

1. Between 11 December 2015 and 8 February 2016, you did not take sufficient action to contact probation in the case of service user A.

2. In the case of service user B you:

a) In or around November 2015, did not complete stage 3 of the safeguarding procedures following a safeguarding referral

3. In the case of service user C, you did not follow up with the Care Agency and/or update them in relation to the safeguarding concern reported by them in March 2015

4. You did not complete a Level 3 safeguarding form on Carefirst and / or convene a Level 3 strategy meeting in the case of:

a) service user D

b) service user E

c) service user F

d) service user H

e) service user I

f) service user J

g) service user K

5. You did not ensure that a mental capacity assessment was undertaken in the case of:

a) service user G

b) service user K

6. You did not liaise with the adult safeguarding unit in the case of:

a) service user E

7. In the case of service user F, you approved the minutes of a strategy meeting held on 23 February 2016 that did not include reference to a safeguarding incident

8. In the case of service user L you did not invite and/or request information from a range of agencies and/or police in relation to a strategy meeting on 18 December 2015

9. You gave incorrect advice to colleague A about whether the case needed to adhere to safeguarding procedures in the case of:

a) service user M

b) service user N

10. You did not authorise the minutes in a timely manner in the case of:

a) service user O for the meeting held on 16 January 2016

b) Service user J for the meeting held on 26 August 2015

c) Service user Q for the meeting held on 4 September 2015

d) Service user H for the meeting held on 15 January 2016

11. The matters set out in paragraphs 1 - 11 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Service

1. On 31 October 2017, the HCPC sent Notice of this hearing by first class post to the Registrant’s registered address. A copy of the Notice was also sent on the same date by email. The Notice contained the required particulars, including time, date and venue.

2. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied on the documentary evidence provided that the Registrant had been given appropriate Notice of this hearing in accordance with the Rules.

Proceeding in absence of the Registrant

3. Ms Manning-Rees, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a registrant's absence should only be exercised with the utmost care and caution.

4. The Panel had regard to the chronology of events. On 30 September 2016, DA, then Acting Service Manager for Mental Health at Newcastle City Council (the Council), referred the matter to the HCPC. On 6 February 2017, a Panel of the Investigating Committee found that there was a case to answer. On 17 May 2017, the HCPC wrote to the Registrant to indicate that it would seek to amend the allegation at the outset of the hearing. On 31 October 2017, the Notice of Hearing was sent to the Registrant and, on 29 November 2017, the Final Hearing bundle was sent to the Registrant. No communications have been received from the Registrant since the referral to date.

5. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve Notice on the Registrant in accordance with the Rules.

6. The allegation dates back to 2015 and 2016, when the Registrant was working as a Team Manager at the Council. The Panel was aware that there is one witness present to give evidence on the first day (15 January 2018).

7. In light of the above, the Panel was satisfied that the Registrant had been provided with the means of knowledge as to when and where his hearing was to take place. The Panel concluded that the Registrant had voluntarily waived his right to attend and there was no evidence that he would attend an adjourned hearing. The Panel also considered that it was in the public interest for this hearing to go ahead.

Application to amend particulars

8. At the beginning of the hearing, Ms Manning-Rees, for the HCPC, applied to amend a number of the particulars.

9. Having heard and accepted the advice of the Legal Assessor, the Panel decided to allow the proposed amendments in full. It was of the view that the amendments essentially reflected the anticipated evidence and clarified timeframes in which the allegations were alleged to have occurred. In addition to the notified amendments, the Panel also re-numbered the particulars to take account of the amendments.

10. Since the initial drafting of the original allegation, a number of occasions had been identified where an omission had been alleged, but the finalised witness statement did not support the alleged omission (original particulars 2(b) to 2(d), and 7). The Panel was satisfied that there would be no prejudice to the Registrant in allowing the proposed amendments as they effectively reduced the number of alleged record-keeping errors.

Admissibility of Evidence by Video-Link

11. Ms Manning-Rees made an application to allow Colleague A to give her evidence by video-link, at a venue closer to her home, rather than travel to London. Colleague A had originally been scheduled to attend the hearing to give evidence. On 10 January 2018, she emailed the HCPC to enquire whether she could attend a venue closer to her home for health reasons.

12. The Panel heard and accepted the advice of the Legal Assessor. The Panel noted that medical evidence confirming that Colleague A had been signed off work due to her health had been received. The Panel considered whether it would be unfair to the Registrant to allow Colleague A’s evidence to be received by way of video-link, noting that it was specifically provided for in the Civil Procedure Rules. Given that the Registrant had neither attended this hearing, nor was he represented, it was not the situation that the Registrant would be deprived of the opportunity for him or a representative to cross-examine the witness face-to-face.

13. The Panel was of the view that it was important to achieve the best evidence where possible. In this case, it concluded that it would be achieved by allowing the witness to give her evidence by video-link. The Panel was satisfied that it would be able to evaluate the reliability of Colleague A’s evidence given by video-link. It therefore allowed the application for Colleague A to give her evidence by video-link.

Background

14. The Registrant was employed by the Council from 22 October 1990. He was suspended from work on 29 February 2016, pending an investigation, and resigned from his post on 10 June 2016. He worked as a Team Manager in the Learning Disability and Autism Team, part of the Wellbeing, Care and Learning Directorate in Adult Services. The Registrant was responsible for 10 Social Work team staff, one of whom was Colleague A, a Social Worker. From April 2015, the Registrant managed a Short Term Assessment Team within the Specialist Service, which worked short term with service users.

15. In terms of safeguarding procedures, the Council followed the Multi-Agency Safeguarding Adults Procedures, which defined the following process:

• Level/Stage 1: information gathering. This should be completed in one working day and documented by a Stage 1 Safeguarding Adults Enquiry Form.

• Level/Stage 2: further information gathering leading into more detailed inquiries and to decide whether an investigation is required. This should be completed in two working days and documented by a Stage 2 Safeguarding Adults Enquiry Form.

• Level/Stage 3: A multi-agency discussion/meeting should take place. This should be competed in five working days. An investigation should then be completed within one month of the meeting and documented by a Stage 3 Safeguarding Adults Enquiry Form.

• Level/Stage 4: A multi-agency meeting and ongoing safeguarding plan should be created. This should be completed within three to six months of the multi-agency meeting.

16. The Council used an electronic-based system for keeping records in respect of service users, known as CareFirst. All contact, assessment and forms for each of the safeguarding levels were expected to be recorded on the CareFirst system. The majority of the recording on a service user’s file would be by the allocated Social Worker, but the expectation was that any direct contact a team manager had with a case, such as communications or action taken, should be recorded by the team manager. Totalview was an extension of CareFirst where any paper documents, such as letters and safeguarding minutes, were scanned onto the system to be retained.

17. The period from April 2015 to December 2015 involved substantial change in the Social Work structures at the Council. There was a significant re-structuring of the teams, with Social Workers changing teams along with cases. The Registrant was closely involved in managing teams directly affected by the changes.

18. In February 2016, a number of concerns came to light from external sources. An investigation was carried out by DF, the Service Manager. It is alleged that the Registrant failed to adhere to the Council’s safeguarding procedures, keep electronic case records up-to-date, or make appropriate decisions to manage safeguarding cases.

Decision on Facts

19. On behalf of the HCPC, the Panel heard oral evidence from the following witnesses:

• DF, the Acting Service Manager for the Council;

• DA, the Acting Service Manager for Mental Health at the Council; and

• Colleague A, a Social Worker at the Council.

20. The Panel was also provided with a documentary exhibits bundle, which included summaries of the investigative interviews, copies of forms, and entries within the CareFirst system for the respective service users who were the subject of the allegation.

21. The Panel heard and accepted the advice of the Legal Assessor. In respect of the facts, the Panel understood that the burden of proving each individual fact was on the HCPC and that the HCPC would only be able to prove a particular fact if it satisfied the required standard of proof: namely the civil standard, whereby it is more likely than not that the alleged incident occurred.

22. The Panel considered the evidence of each of the witnesses. It was of the view that all three were credible in their evidence. Each was knowledgeable about their individual roles and responsibilities, although each saw the case from a different perspective. DF was brought into the role of senior management at a time of significant change, with responsibilities for implementing that change; DA was one of the Acting Service Managers; and Colleague A was a Social Worker facing the challenges of delivering social care in the context of the extensive re-structuring taking place.

23. DF was the then Acting Service Manager, responsible for a number of teams, including the Learning Disability and Autism Team, Community Health and Social Care Direct, and a sexual health advice service. He was in this role from December 2015 to April 2016. DF was the Registrant’s Line Manager from December 2015, and conducted two supervision sessions with him before the Registrant was suspended in February 2016 and subsequently left the organisation in June 2016.

24. When the concerns came to light, DF was appointed as the Investigating Officer. In that role he checked all cases for which the Registrant had managerial responsibility, reviewing them against the CareFirst and Totalview records; he looked at the Safeguarding meetings which the Registrant had chaired over the previous year; and he carried out a fact-finding interview with the Registrant on 29 February 2016 and an investigative interview on 8 March 2016.

25. The Panel considered DF to be credible, thorough, and he provided a chronology and context to all of the changes the Council were going through at the time. He had been appointed as the Acting Service Manager at a time when a new model for the delivery of Social Care Services was being implemented, the Care Act was being implemented, creating additional work, Social Work teams and departments were being re-structured, and there were budget cuts.

26. DA was the Acting Service Manager for Mental Health at the Council from October 2015 to April 2016. From April 2016 she became the Acting Service Manager with responsibility for the Learning Disabilities and Autism Team. The Panel considered her to be credible on a professional basis, but the evidence she was able to provide was very narrow in scope. Aside from Service User A, she did not have first-hand knowledge of the cases, nor had she been through the service user records on CareFirst during the investigation. Her remit in the investigation had been to meet with members of the Registrant’s team to review their caseloads and ensure all safeguarding concerns were being managed. She had also been asked to make the referral to the HCPC and later provide specific information in response to queries from the HCPC. Given this limited remit, the Panel found that the information which DA was able to provide was of limited assistance to it.

27. Colleague A was a Social Worker at the Council, having qualified in August 2014. The Registrant was her Line Manager from December 2015 until 29 February 2016. The Panel considered that her evidence provided a real insight as to the level of upheaval involved in the changes, and the personal and professional impact on individual Social Workers charged with delivering frontline services in the context of such changes and budget cuts.

Particular 1 – Not Proved

1. Between 11 December 2015 and 8 February 2016, you did not take sufficient action to contact Probation in the case of service user A

28. The Panel finds particular 1 not proved.

29. Service User A had appeared at Newcastle Crown Court in respect of having a bladed article and placing an article with intent (bomb hoax). He had been found unfit to stand trial, but on 11 December 2015 a jury had found that he did the acts charged. The judge had adjourned sentencing of the case for consideration of a supervision order, tasking the Probation Service (Probation) to agree with Adult Services as to who would take on the role of named supervisor.

30. The Panel had regard to the observation logs on CareFirst. There was an incomplete entry by DA, for 9 December 2015, to the effect that she had received a telephone call from Service User A’s solicitor. The entry indicated that she had previously discussed the case with the solicitor, as well as a member of the Court Mental Health Team and the CPS, in relation to the recommendation in the psychiatric report prepared for sentencing that Service User A should receive a supervision order. There was a further entry, dated 11 December 2015, of a message sent by DA to the Registrant to the effect that she had received a telephone call from the solicitor to inform her of the jury’s verdict and that the judge had adjourned sentencing, tasking Probation to agree with Adult Services as to who would take on the role of named supervisor. In that message, DA had written: “[The solicitor] has given the Probation officer my name and asked him to contact me. However, I will re-direct him to you…”. DA’s evidence was that she had never been contacted by Probation.

31. The Panel was not provided with documentation to demonstrate that the responsibility for contacting Probation was with the Registrant, beyond DA’s note to say that she would re-direct the anticipated Probation Officer’s telephone call. Further, DA had said that the request for Social Services’ involvement was unusual, as it would normally be Probation who would monitor a court sentence of supervision. The Panel considered that the nature of DA’s message to the Registrant indicated that, as at 11 December 2015, the Registrant should expect a call from Probation. DA had said that no such call was received from them. In the fact-finding interview, the Registrant explained that he had been making efforts to contact Probation and that he had left messages with them. The Panel accepted this explanation, in light of an email from DF to the Registrant, dated 8 February 2016, in which DF asked the Registrant to keep trying with the solicitor.

32. The Panel was provided with a copy of a Crown Court Order, dated 29 December 2015, ordering that discussions take place between the Council and Probation, with agreement to be reached. It identified the next hearing date as 12 February 2016 and ordered both parties to attend the court hearing. This Order had a ‘date received’ stamp of 9 February 2016 and appeared to have been forwarded to the Registrant on 11 February 2016, following which the Registrant was able to resolve the matter without a Social Worker being required to attend court. DF’s criticism of the Registrant was that he had not been proactive enough once no contact had been received from Probation.

33. The Panel was not satisfied to the required standard that the actions taken by the Registrant were insufficient in the circumstances. There was some uncertainty as to where the responsibility for the case lay, and the responsibility had been with Probation to contact Social Services. The Registrant had made efforts to initiate contact with Probation once there had been no contact received from them, but without success.

Particular 2(a) – Proved

In the case of service user B you:

a) In or around November 2015, did not complete stage 3 of the safeguarding procedures following a safeguarding referral

34. The Panel finds particular 2(a) proved.

35. Service User B was a vulnerable 19-year-old woman living in temporary accommodation who had previously been referred to the Registrant’s team for assessment by the Learning Disabilities Team. On 4 November 2015, a safeguarding referral was sent by the Police to the effect that Service User B had sustained an alleged sexual assault. The CareFirst records indicated that this was allocated to the Registrant’s team on 5 November 2015, and the Registrant received a specific message about a Level 3 safeguarding alert on 16 November 2015. DF said that it was the responsibility of the Team Manager to take a case through the Level 3 stage.

36. The Panel accepted the evidence of DF that, during his inquiry, he had gone through the records and entries on both CareFirst and Totalview and there were no records or minutes of a Level 3 strategy meeting or discussion, nor was there a Level 3 form completed by the Registrant.

37. The Panel had regard to the Registrant’s response in the investigative interview. He said that he thought he had passed the case over to another team, as he was about to go on leave, but he could not be sure as it was a busy time and teams were changing. He said that he had not realised the case was still with him and, in hindsight, should have recorded any such conversation with a manager.

38. Given the absence of any documentation regarding Level 3 safeguarding, and the Registrant’s own response that he had not realised the case was still with him, the Panel was satisfied to the required standard that the Registrant had not completed Stage 3 of the safeguarding procedures following the police safeguarding referral.

Particular 3 – Proved

3. In the case of service user C, you did not follow up with the Care Agency and/or update them in relation to the safeguarding concern reported by them in March 2015

39. The Panel finds particular 3 proved.

40. Service User C was a 49-year-old man with learning disabilities who had no allocated Social Worker at the time. Safeguarding concerns were reported by Service User C’s care agency to the Care Services Officer in March 2015, to the effect that Service User C’s brother may be financially abusing Service User C.

41. On 23 March 2015, the matter was re-assigned to the Registrant. The CareFirst records indicated that a safeguarding concern form was completed and a safeguarding alert form was opened to the Registrant (equivalent to Levels 1 and 2 of the safeguarding process), but the matter did not progress to Level 3. CareFirst records indicated that the care agency telephoned Adult Services on 17 April 2015 requesting feedback about the case. DF’s evidence was that the appropriate safeguarding actions had been taken. His criticism was that the Registrant had not notified the care agency of the outcome of the case.

42. The Registrant, in his investigation interview, accepted that he had not fed back to the care agency. He said that he had forgotten about it. It had come at the end of being on call, they were setting up the new team, and he was not making good use of the ‘assessments tab’ on CareFirst. He observed that he had about 60 cases coming back to him and three agency staff in succession. It was in this context that he had forgotten to feed back.

43. In light of the Registrant’s acceptance that he had forgotten about the case, the Panel was satisfied that, as a matter of fact, the Registrant had not followed up with the care agency or updated them on the outcome of their concern. However, the Panel was mindful of the context in which this occurred, namely the setting up of a new team which the Registrant was heading up, with 60 new cases coming in and changing agency staff, all of which meant that the Registrant had to prioritise the work load and this was a case which was not progressing to Level 3 safeguarding.

Particular 4(a) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

a) service user D

44. The Panel finds particular 4(a) proved in respect of both not convening a Level 3 strategy meeting and not completing a Level 3 safeguarding form on CareFirst.

45. Service User D was a 25-year-old woman with a learning disability. On 16 October 2015, information was received from Service User D’s GP, who expressed concern that Service User D was at significant risk of harm as she seemed unable to maintain her own safety and hygiene and was at risk of eviction.

46. The CareFirst records indicated that, on 19 October 2015, the assessment for a ‘Stage 3 Safeguarding Adults Enquiry (Strat)’ was assigned to the Registrant, and that the message assigning the case was opened on 26 October 2015. The Panel had copies of the Level 1 and Level 2 assessment forms. The final question on the Level 2 form read “Is this the end of safeguarding adults procedures?”, to which the answer “No” had been recorded. Neither CareFirst nor Totalview contained any records or minutes of a Level 3 strategy meeting, nor a completed Level 3 form.

47. The Registrant, in the investigative interview, said that there had been strategy discussions, including with the housing provider and the Community Team Learning Disability (CTLD), but these had not been written up. He acknowledged that it had been an oversight not to complete the forms, but his judgement was that Service User D’s needs were being managed by other professionals.

48. In the absence of forms on CareFirst or Totalview, the Panel was satisfied that whilst the Registrant had had strategy discussions with other agencies, he had not convened nor held a specific Level 3 strategy meeting. As no such meeting had taken place, the Panel was satisfied that the Registrant had not completed a Level 3 form on CareFirst.

Particular 4(b) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

b) service user E

49. The Panel finds particular 4(b) proved both in respect of both not convening a Level 3 strategy meeting and not completing a Level 3 safeguarding form on CareFirst.

50. Service User E was a 35-year-old man with a learning disability. A referral was received from Service User E’s GP, concerned about unexplained bruising on Service User E’s arm. On 7 December 2015, a Stage 1 safeguarding enquiry was started and, on 8 December 2015, a Stage 2 safeguarding enquiry form was completed. CareFirst shows that the case was reassigned to the Registrant on 15 December 2015 for a ‘Stage 3 Safeguarding Adults Enquiry (Strat)’. Neither CareFirst nor Totalview contained any records or minutes of a Level 3 strategy meeting, nor a completed Level 3 form.

51. The Registrant, in the fact-finding interview, said that he had requested body charts from the agency and a report was due. In the investigative interview, when asked why he had not followed up on the report, he said that he had not made sufficient use of the ‘assessments tab’ on CareFirst, which would have reminded him that it was due.

52. In the absence of Level 3 forms on CareFirst or Totalview, and the Registrant’s comments in the interview, the Panel was satisfied that the Registrant had not convened or held a Level 3 strategy meeting. As no such meeting had taken place, the Panel was satisfied that the Registrant had not completed a Level 3 form on CareFirst.

Particular 4(c) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

c) service user F

53. The Panel finds particular 4(c) proved insofar as it relates to not completing a Level 3 safeguarding form on CareFirst.

54. Service User F was an 18-year-old woman with a learning disability. On 28 January 2016, Colleague A had attended the police station to act as an appropriate adult on behalf of Service User F, who was interviewed by police about an alleged assault on her grandmother. A further referral had also been received by Service User F’s service provider that, on 3 February 2016, Service User F had been threatened by a neighbour and his friend in the flat downstairs when she had been in the flat for drink. The neighbour’s friend had physically threatened Service User F, saying he wanted her flat. The police had been called and the neighbour had been arrested and bailed not to return to the flat.

55. On 29 January 2016, Colleague A had completed a Safeguarding Adults Enquiry form in respect of the alleged assault by Service User F on her grandmother. In that form, she recorded Service User F’s account to the police that she had pulled her grandmother’s hair, causing her to fall, but that prior to that, her grandmother had pushed her, and a male had placed her in a headlock. On 12 February 2016, Colleague A completed a Level 2 Safeguarding Enquiry form. In that form she recorded: “Risks identified in relation to paid carer allegedly assaulting [Service User F]. Also raises issues in relation to the volatile relationships within the family. This will be progressed to stage 3 to discuss on-going risks due to a number of safeguarding risks identified through various alerts”.

56. On 5 February 2016, Colleague A completed a Stage 1 enquiry form in respect of the incident with the neighbour on 3 February 2016 and, on 12 February 2016, she completed a Stage 2 enquiry form in respect of it. The case was escalated to a Level 3 strategy meeting, and email correspondence, dated 10 February 2016, from the Community Nurse in the CTLD, invited Colleague A and a number of other professionals to the Level 3 strategy meeting on 23 February 2016. The case was allocated to the Registrant on 12 February 2016. On 23 February 2016, the Registrant chaired the Level 3 strategy meeting and a further meeting was planned for 5 April 2016. Minutes were taken and sent to the Registrant for approval on 26 February 2016. The minutes were authorised by the Registrant on 29 February 2016. No completed Level 3 safeguarding form was located on CareFirst by DF in his investigation.

57. The Registrant, in his interview on 8 March 2016, pointed out that the meeting had taken place the previous week. In the investigative interview, he said he would have used the minutes to inform the Stage 3 notes. In his ‘Amendments, Clarifications and Additions’ document, regarding the investigative interview, and signed and dated 21 March 2016, the Registrant said that he had arranged a meeting for the relevant parties which occurred and was minuted. He had signed off the minutes on 29 February 2016 and, later that day, would have signed off the Stage 3 but was suspended.

58. In the absence of a completed Level 3 form on CareFirst, and the Registrant’s comments in the interview, the Panel was satisfied that the Registrant had not, in fact, completed at Level 3 form on CareFirst.

Particular 4(d) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

d) service user H

59. The Panel finds particular 4(d) proved insofar as it relates to not completing a Level 3 safeguarding form on CareFirst.

60. Service User H was a 30-year-old woman with a learning disability. On 21 December 2015, her parents wrote to Adult Services to allege financial exploitation from another resident where Service User H lived. On 31 December 2015, Safeguarding Enquiry forms for Level 1 and Level 2 were completed. On 5 January 2016, the Registrant received a message to inform him of the Level 3 strategy meeting which had been convened for 15 January 2016. On 15 January 2016, the Registrant chaired the Level 3 strategy meeting. No completed Level 3 safeguarding form was located on CareFirst by DF in his investigation. Following the meeting, the CareFirst observation logs indicated that a Finance Support Plan Assessment was drawn up and authorised by a Social Worker, AD, on 26 January 2016.

61. In the absence of a completed Level 3 form on CareFirst, and the Registrant’s comments in the interview, the Panel was satisfied that the Registrant had not, in fact, completed a Level 3 form on CareFirst.

Particular 4(e) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

e) service user I

62. The Panel finds particular 4(e) proved insofar as it relates to not completing a Level 3 safeguarding form on CareFirst.

63. Service User I was a 19-year-old man with learning disabilities. An allegation was made by the service provider to say that they had noticed bite marks on Service User I and he had allegedly told the service provider that a family member had caused this. One of his family members was also employed as a personal assistant to him. On 12 January 2016, Level 1 and Level 2 safeguarding forms were completed and Service User I was placed in emergency accommodation at that point. On 28 January 2016, the Registrant chaired a Level 3 strategy meeting. The Registrant had signed the minutes of the meeting on 18 February 2016. No completed Level 3 safeguarding form was located on CareFirst by DF in his investigation, although on 22 February 2016, the minutes of the meeting were circulated to the relevant professionals who had attended the meeting.

64. The Registrant, in his interview of 8 March 2016, in answer to the question of whether there was any reason why the Stage 3 documentation was not completed, said that he was waiting for the minutes to come through in the February, which he would then use to complete the Level 3 documents.

65. In the absence of a completed Level 3 form on CareFirst, and the Registrant’s comments in the interview, the Panel was satisfied that the Registrant had not, in fact, completed a Level 3 form on CareFirst.

Particular 4(f) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

f) service user J

66. The Panel finds particular 4(f) proved insofar as it relates to not completing a Level 3 safeguarding form on CareFirst.

67. Service User J was a 28-year-old woman with a learning disability. She was referred by police because of a safeguarding allegation about the risk of domestic violence from her partner. On 17 July 2015, a Level 1 safeguarding enquiry was started and the Level 2 safeguarding enquiry was completed. The allocated Social Worker, who gathered the information as part of the Level 2 enquiry, noted on the form that the Registrant recommended a “review of Safeguarding on my return from annual leave”. On 26 August 2015, the Registrant chaired a Level 3 strategy meeting. No completed Level 3 safeguarding form was located on CareFirst by DF.

68. The Registrant was not asked about this allegation in either his investigation interview of 29 February 2016 or his subsequent interview of 8 March 2016.

69. In the absence of a completed Level 3 form on CareFirst, the Panel was satisfied that the Registrant had not, in fact, completed a Level 3 safeguarding form on CareFirst.

Particular 4(g) – Proved

You did not complete a Level 3 safeguarding form on Carefirst and/or convene a Level 3 strategy meeting in the case of:

g) service user K

70. The Panel finds particular 4(g) proved both in respect of not convening a Level 3 strategy meeting and not completing a Level 3 safeguarding form on CareFirst.

71. Service User K was a 28-year-old man with a learning disability who had been accommodated by an Independent Supported Living (ISL) Scheme. He had made an allegation that another resident had sexually assaulted him. On 29 September 2015, a Level 1 safeguarding enquiry was started by the allocated Social Worker, and completed on 2 October 2015. On 9 October 2015, a Stage 2 enquiry was completed. No further action was taken after the Stage 2 enquiry.

72. The Registrant was not asked about this allegation in either his investigation interview of 29 February 2016 or his subsequent interview of 8 March 2016.

73. In the absence of a completed Level 3 form on CareFirst, the Panel was satisfied that the Registrant had not, in fact, completed a Level 3 form on CareFirst.

Particular 5(a) – Not Proved

You did not ensure that a mental capacity assessment was undertaken in the case of:

a) service user G

74. The Panel finds particular 5(a) not proved.

75. Service User G was a 57-year-old woman who was referred by her sister, who said that Service User G had a learning disability which had not been recognised or diagnosed. The sister referred an allegation of serious financial abuse. Level 1 and Level 2 safeguarding enquiry forms were started and completed on 24 July 2015 by the Community Mental Health and Social Care Direct Team. The concerns identified on the forms were that Service User G had sold her house and the proceeds had gone to her daughter, leaving Service User G in rented accommodation with significant rent arrears and at risk of homelessness. On 12 August 2015, the case was referred to the Specialist Services Assessment Team, which the Registrant managed. On 14 August 2015, a CareFirst message was sent by AD to the Registrant, saying: “[the Community Mental Health and Social Care Direct Team] has added some extra information to observation and added activities. She has visited twice and feels [Service User G] has capacity to consent to referral for safeguarding processes which she has”.

76. The CareFirst observation logs documentation which was before the Panel indicated that on 4 August 2015, the Community Mental Health and Social Care Direct Team made a referral to Money Matters, a homelessness and debt agency. On 24 August 2015, a telephone call was recorded as having been received from the Debt Officer at Money Matters, and on 4 September 2015 a further telephone call was recorded as received from the Debt Officer, raising concerns about possible eviction and non-entitlement to benefits, and requesting a Social Worker be allocated.

77. On 21 September 2015, DZ (floating support) was allocated to Service User G. The observation logs record a number of agencies and professionals involved throughout Services User G’s ongoing financial issues, appeal against refusal to award benefits, and a pending court hearing regarding eviction. On 4 December 2015, DZ recorded on the observation logs that the Debt Officer had been told by Service User G that she gave her (Service User G’s) daughter’s partner the money from the sale of the home willingly, and Service User G’s solicitor had emailed to say that Service User G had agreed that all of the proceeds from the sale of her home were to be given to the daughter’s partner. On 10 December 2015, DZ recorded on the observation log that she had visited Service User G as arranged and that Service User G “seems extremely capable, no evidence of any disabilities”.

78. The Registrant, in his interview of 8 March 2016, said that further work within the team had established that Service User G did not have a learning disability. She was aware as to what had happened with the proceeds of the house. She was difficult to engage with, but it was felt that she was aware as to what had happened and had decided to move to Essex.

79. The concerns of an unrecognised or undiagnosed learning disability had come from Service User G’s sister in the initial referral. The Panel was of the view that, following referral, there was a significant level of ongoing input from a number of professionals, including an allocated Social Worker, solicitor and Debt Officer, none of whom appeared to have raised particular concerns in respect of Service User G’s mental capacity. In light of this, the Panel was not satisfied to the required standard that the HCPC had proved that a Mental Capacity Assessment was required. It concluded that it was a matter for the Registrant’s professional judgement, as manager, as to whether or not to direct that a Mental Capacity Assessment be carried out. In the circumstances of this case, the Panel was not satisfied that there was a responsibility on the Registrant, as manager, to ensure that such an assessment was undertaken for Service User G.

Particular 5(b) – Not Proved

You did not ensure that a mental capacity assessment was undertaken in the case of:

b) service user K

80. The Panel finds particular 5(b) not proved.

81. Service User K was a 28-year-old man with a diagnosed learning disability who had been accommodated by an ISL Scheme. On 23 September 2015, he made an allegation that another resident had sexually assaulted him. Within the Level 2 safeguarding enquiry form completed on 9 October 2015, and authorised by the Registrant, the Social Worker completing the form had recorded the default position of ‘not determined’ in response to the question of whether the service user had mental capacity in relation to making decisions about their safety.

82. In the Level 2 enquiry form, the Social Worker had recorded that Service User K “does not wish to pursue his allegation with the Police however he would like [the ISL Scheme] to be informed so that the same thing does not happen to someone else in the future”. The Social Worker had recorded that the ISL Scheme had conducted an internal investigation, speaking to both the alleged perpetrator and his parents and, moving forward, had indicated that they would monitor his interactions with other residents. The Social Worker had also recorded his assessment in that form that there were no current risks to the alleged victim as he had moved back in with his mother and was no longer in contact with the alleged perpetrator.

83. The Registrant was not asked about Service User K in either his investigation interview of 29 February 2016 or in his interview of 8 March 2016.

84. The Panel considered that it was a matter for the Registrant’s professional judgement, as manager, having reviewed the information gathered and assessed by the Social Worker, as to whether or not to direct that a Mental Capacity Assessment be carried out. In these circumstances, the Panel was not satisfied that there was a responsibility on the Registrant, as manager, to ensure that such an assessment was undertaken for Service User K.

Particular 6(a) – Proved

You did not liaise with the adult safeguarding unit in the case of:

a) service user E

85. The Panel finds particular 6(a) proved.

86. Service User E was a 35-year-old man with a learning disability who lived in 24-hour supported living provided by an agency. A referral was received from Service User E’s GP, who was concerned about unexplained bruising on Service User E’s arm. The ‘Safeguarding Adults Enquiry (Info)’ form recorded that staff at the supported living residence were unable to explain how or why the bruising had occurred. It was also recorded in the form that staff at the agency carried out a daily bruise chart because of previous incidents of unexplained bruising. On 3 December 2015, the Level 3 safeguarding form was allocated to the Registrant. DF said that at the time of its allocation, the Registrant should have made contact with the Safeguarding Adults Unit (the Unit) and he did not.

87. DF said that the Unit was involved in cases where the alleged perpetrator was a paid worker or where there was a concern about institutional or organisational abuse. The Unit’s Policy required that there should be liaison with the Unit in such cases as it might be aware of other concerns with the service provider.

88. In his interview of 8 March 2016, the Registrant said that he had requested body charts from the agency and a report was due. When asked why he had not followed up on that, he said that he had not made sufficient use of the ‘assessments tab’ on CareFirst, which would have reminded him that it was due.

89. The Panel was of the view that the Policy was clear in requiring any concern that a paid worker was involved to be reported to the Unit. The Panel considered that the information recorded in the Level 2 form raised such a concern. Therefore, the Panel was satisfied that the Registrant did not liaise with the Unit, but he should have done so, in accordance with the Policy.

Particular 7 – Not Proved

In the case of service user F you approved the minutes of a strategy meeting held on 23 February 2016 that did not include reference to a safeguarding incident

90. The Panel finds particular 7 not proved.

91. Service User F was an 18-year-old with a learning disability. The Level 2 strategy form, completed by Colleague A on 12 February 2016, and approved by the Registrant on 15 February 2016, has an entry by Colleague A stating that “Risks identified in relation to paid carer allegedly assaulting [Service User F]. Also raises issues in relation to the volatile relationships within the family. This will be progressed to stage 3 to discuss on-going risks due to a number of safeguarding risks identified through various alerts”.

92. The Panel had regard to the minutes of the strategy meeting held on 23 February 2016 and authorised by the Registrant on 29 February 2016. The Panel was satisfied, therefore, that the Registrant had approved the minutes. The minutes included a chronology of a number of incidents of concern or abuse, with a brief summary of each incident. The chronology and summaries included the incident on 29 January 2016 of the alleged assault by Service User F on her grandmother and counter-allegations made by Service User F; and the matter in early February 2016 involving the downstairs neighbour. Both these incidents, in the Panel’s view, were safeguarding incidents.

93. Although the minutes themselves did not set out the precise terms of the counter-allegation by Service User F, or that it included a male (caring for a disabled son of Service User F’s grandmother) who had placed Service User F in a headlock, the Panel was satisfied that the summary included a reference to it. This, together with the summaries of the other safeguarding incidents, led the Panel to conclude that the minutes which the Registrant had approved did include reference to a safeguarding incident.

Particular 8 – Not Proved

In the case of service user L you did not invite and/or request information from a range of agencies and/or police in relation to a strategy meeting on 18 December 2015

94. The Panel finds particular 8 not proved.

95. Service User L was a 60-year-old woman who had a learning disability, physical health problems, and a history of alcohol dependency. This was a long-standing case where Service User L’s son was considered high risk, and was managed by Multi-Agency Public Protection Arrangements (MAPPA) coordinated by Probation. A referral was made by Service User L’s care provider that Service User L’s son was soon to be released from prison in January 2016. On 10 December 2015, Level 1 and Level 2 Safeguarding Enquiry forms were completed by the Community Health and Social Care Direct Team, and on 18 December 2015, the Registrant chaired a Level 3 strategy meeting.

96. The Panel had regard to the minutes of the Level 3 strategy meeting, which had been authorised by the Registrant on 5 January 2016. In the list of attendees recorded in the minutes, in addition to the Registrant and the minute taker, representatives from ‘Floating Support’, ‘Housing and Well Being’, and ‘Outreach’ were listed as present. The minutes did record that there were no apologies from non-attendees, but did not record who had been invited but had not attended. The minutes identified the concerns in safeguarding Service User L in respect of her son, who was due to be released from prison.

97. Letters of the minutes were sent out to the listed attendees of the strategy meeting, as well as the Community Nurse, the Community Psychiatric Nurse, and the Police Detective Inspector at MAPPA. From the covering letters which were sent out with the minutes, the Panel inferred that the two nurses and the police would have been invited to the strategy meeting, although they had not attended. From the contents of the minutes, the Panel inferred that information had been sought from and provided by the police and health care professionals, to be discussed at the strategy meeting. There was no evidence before the Panel of who had sought the information or sent out the invitations to the strategy meeting.

98. The Registrant, in his interview of 8 March 2016, said that the police were informed and Safeguarding continued to share information with Probation. 99. In all the circumstances, the Panel was not satisfied to the required standard that the Registrant had not invited or requested information from a range of agencies or the police in relation to the strategy meeting.

Particular 9(a) – Proved

You gave incorrect advice to colleague A about whether the case needed to adhere to safeguarding procedures in the case of:

a) service user M

100. The Panel finds particular 9(a) proved.

101. Service User M was a 19-year-old woman with a learning disability who lived with her mother. There were ongoing concerns regarding financial abuse by the mother; concerns that the mother locked herself in the bedroom for prolonged periods; concerns that the mother was turning away support workers; and that Service User M had allegedly hit her mother. There were also long-term concerns with Service User M dating back to 2012. This was considered a complex case, which had had numerous serious safeguarding concerns prior to the involvement of Colleague A or the Registrant. These also included numerous reported physical altercations between Service User M and her mother, with both parties being instigators, and concerns of financial abuse by the mother.

102. On 26 February 2016, the mother of Service User M emailed Colleague A to ask if her daughter’s placement was ready as her behaviour was getting worse, and she (the mother) had locked herself in her room for a number of hours in fear of Service User M. In response, Colleague A suggested to the mother that Service User M go into an interim residential placement until her permanent placement was ready, which was due to be 13 March 2016.

103. On 26 February 2016, Colleague A spoke to the Registrant about the case. The advice that he gave was to move Service User M to an interim placement until 13 March 2016, and to raise the safeguarding procedures for the mother, not for Service User M. Colleague A completed a Level 1 Safeguarding Enquiry form on the same day, with Service User M as the perpetrator and the mother as the victim, and detailing the risks from Service User M to her mother as well as from Service User M’s mother to her. The result of this was that the Level 1 Safeguarding Enquiry form was recorded on the mother’s file, but not on Service User M’s file.

104. Colleague A said she considered there to be risks to Service User M from the mother and therefore safeguarding forms should have been considered for both Service User M and her mother.

105. The Registrant, in his interview of 8 March 2016, said that there was discussion (between him and Colleague A) about how they would manage the risk, and that they had appointeeship to move Service User M to ISL accommodation. When asked about money before the appointeeship, the Registrant said it was considered and they were managing her access to money when she was living in the mother’s house.

106. The Panel considered that the advice, insofar as it related to not raising a safeguarding enquiry in respect of Service User M, was incorrect. Although the Panel noted that there was a lot of input in respect of placing Service User M in a permanent supported living residence, which lessened the risk to her, at the time the advice was given, there were apparent safeguarding concerns for Service User M as well as her mother. In such circumstances, the safeguarding procedures for completing safeguarding enquiry forms in respect of Service User M as well as her mother should have been followed. The Panel was satisfied to the required standard that to advise otherwise was incorrect.

Particular 9(b) – Proved

You gave incorrect advice to colleague A about whether the case needed to adhere to safeguarding procedures in the case of:

b) service user N

107. The Panel finds particular 9(b) proved.

108. Service User N was a 50-year-old man with a possible diagnosis of autism who had been referred for a formal diagnosis. On 20 November 2015, a GP referred Service User N to Adult Services, stating: “his personal hygiene is poor and this has on a number of occasions resulted in skin infections which become more serious necessitating hospital admission”. There were also significant issues about the state of his property. On 23 December 2015, the on-call worker saw Service User N and recommended an urgent assessment. The case was allocated to Colleague A on 5 January 2016. On 10 February 2016, Colleague A completed a joint visit with the Mental Health team to Service User N.

109. On 16 February 2016, the CareFirst observation logs recorded the discussion between Colleague A and the Registrant. Colleague A recorded: “Discussion with [the Registrant] re number of concerns for [Service User N] in relation to self neglect [sic], potential weapons in home and risk to workers. [The Registrant] advised to share info with the police and emailed me cleaner home protocol”. Colleague A, in her HCPC witness statement, also said that the Registrant’s advice included informing the GP. Following the discussion with the Registrant, Colleague A emailed the concerns to the police and sent a letter to Service User N’s GP. She did not follow up on the cleaner home protocol as Service User N gave notice on and moved out of his flat and on to a different Local Authority area.

110. Colleague A said that she considered that the advice should have included starting safeguarding procedures and completing a Stage 1 form at that point, in order to fully consider the safeguarding risks to Service User N and then move onto the following levels if necessary.

111. The Panel considered that the advice given by the Registrant was insufficient. The advice to inform both the police and Service User N’s GP was, in the Panel’s view, appropriate. However, in light of the potential safeguarding issues, the Panel was satisfied that in omitting to advise Colleague A to follow the Adult Safeguarding procedures and move to a Level 1 Safeguarding Enquiry, the Registrant’s advice had been incorrect.

Particular 10(a) – Proved

You did not authorise the minutes in a timely manner in the case of:

a) service user O

112. The Panel finds particular 10(a) proved.

113. Service User O was a 36-year-old man with a learning disability. On 21 December 2015, a Community Nurse passed on concerns about a range of issues including: self-neglect; potential financial abuse; people staying at or coming into his property; alleged use of drugs; and consequent debt. On 22 December 2015, Colleague A completed Level 1 and Level 2 Safeguarding Enquiry forms, and the case was progressed to Level 3.

114. On 6 January 2016, the Registrant chaired a Level 3 strategy meeting, at which minutes were taken by a minute-taker. On 13 January 2016, the minutes were sent to the Registrant for approval. The Registrant did not authorise the minutes, so copies were never sent out to the attendees of the meeting, nor put onto the electronic social care record.

115. Following the 6 January 2016 strategy meeting, the Panel noted that the Registrant left his employment on 29 February 2016. The Panel considered that there was a period of around six weeks between receiving the minutes on 13 February 2016 and leaving the Council on 29 February 2016 during which the Registrant would have been in a position to authorise the minutes. The Panel was satisfied to the required standard from the documentation that the Registrant had not authorised the minutes for the meeting, and, in not doing so before he left the Council, he had not authorised them in a timely manner.

Particular 10(b) – Proved

You did not authorise the minutes in a timely manner in the case of:

b) service user J

116. The Panel finds particular 10(b) proved.

117. Service User J was a 28-year-old woman with a learning disability, who was referred because of a safeguarding allegation about the risk of domestic violence from her partner. On 17 July 2015, Level 1 and Level 2 Safeguarding Enquiry forms were completed and the matter was progressed to Level 3.

118. On 26 August 2015, the Registrant chaired a Level 3 strategy meeting. The Panel had a copy of the minutes of that meeting, and it was clear that the Registrant had not signed the minutes to indicate his approval of the minutes. The Panel was satisfied to the required standard, from the documentation, that the Registrant had never authorised the minutes for that meeting, and so had not authorised them in a timely manner.

Particular 10(c) – Proved

You did not authorise the minutes in a timely manner in the case of:

c) service user Q

119. The Panel finds particular 10(c) proved.

120. Service User Q was a 54-year-old woman with learning disabilities. On 10 April 2015, Social Care Direct received an allegation about an alleged sexual assault in respect of Service User Q. Level 1 and Level 2 Safeguarding Enquiry forms were completed. Police were involved and plans were put in place to protect Service User Q in the short term. On 24 April 2015, the Registrant chaired a Level 3 strategy meeting. On 19 May 2015, minutes were sent out to the Registrant and were posted out to attendees on 28 May 2015 following approval. On 22 May 2015, a further Level 3 strategy meeting was chaired by the Registrant. On 25 May 2015, the minutes for that meeting were sent to the Registrant, which were authorised by him on 29 May 2015 and sent out to attendees on 1 June 2015.

121. On 4 September 2015, there was a Level 4 Protection Plan safety meeting chaired by the Registrant. On 20 October 2015, the minutes were sent to the Registrant for his approval. The Panel had a copy of the minutes of that meeting, and it was clear that the Registrant had not signed the minutes to indicate his approval of them. The Registrant did not authorise the minutes, so copies were never sent out to the attendees of the meeting, nor put onto the electronic social care record.

122. In respect of the Level 4 Protection Plan safety meeting on 4 September 2015, the Panel was satisfied to the required standard, from the documentation, that the Registrant had never authorised the minutes for that meeting, and so had not authorised them in a timely manner.

Particular 10(d) – Proved

You did not authorise the minutes in a timely manner in the case of:

d) service user H

123. The Panel finds particular 10(d) proved.

124. Service User H was a 30-year-old woman with a learning disability. Her parents wrote to Adult Services to allege financial exploitation by another resident where Service User H lived. On 31 December 2015, Level 1 and Level 2 Safeguarding Enquiry forms were completed and the matter was progressed to Level 3.

125. On 15 January 2016, the Registrant chaired a Level 3 strategy meeting. On 22 January 2016, the minutes were sent to the Registrant for authorisation. The Registrant did not authorise the minutes, so copies were never sent out nor recorded on the electronic recording system.

126. In respect of the Level 3 strategy meeting held on 15 January 2016, the Panel was satisfied to the required standard, from the documentation, that the Registrant had never authorised the minutes for that meeting, and so had not authorised them in a timely manner.

Statutory Grounds and Impairment

127. The Panel next considered whether the matters found proved as set out above amounted to misconduct and/or lack of competence, and if so, whether by reason thereof, the Registrant's fitness to practise is currently impaired.

128. The Panel heard and accepted the advice of the Legal Assessor. The Panel was aware that any findings of lack of competence and/or misconduct and impairment were matters for the independent judgement of the Panel. The Panel was aware that consideration of impairment only arises in the event that the Panel judges that the facts found proved do amount to misconduct and/or lack of competence and that what has to be determined is current impairment; that is, looking forward from today.

Decision on Grounds

129. The Panel went on to consider whether the facts found proved amounted to lack of competence and/or misconduct.

130. The Panel considered that the Registrant was an experienced Social Worker of some 26 years, who had been promoted to the role of manager, responsible for a number of other Social Workers, including Colleague A. The Panel did not consider that the nature of the Registrant’s failures was such that he did not understand the safeguarding role of a Social Worker. The Panel did not consider that the facts found proved amounted to a lack of competence on his part.

131. The Panel looked at the environment which existed at the Council at the time. The evidence before the Panel indicated that the Adult Services at the Council were undergoing significant change and re-structuring when the Registrant was Colleague A’s line manager. Colleague A also said that their team was created (as well as other teams) very suddenly after this re-structuring, which caused great upheaval. This resulted in an environment that was more stressful and challenging than usual.

132. DF had confirmed to the Panel that the re-structuring essentially comprised three stages. Stage 1 took place before April 2015 and included implementation of the statutory framework of the Care Act, creating the new model for change, and the actual re-structuring of Adult Services. Stage 2 took place between April 2015 and December 2015 and involved the implementation of the re-structuring, with the appointment of the team managers for the newly created teams. Stage 3 was the period post-December 2015, once the re-structure had been completed, and was when DF took over as the Registrant’s Line Manager. DF explained that there was no formal change programme or management framework for the re-structuring process and accepted that it was a complex time for the team managers. He said that there was a Service Improvement Lead to support team managers, but no management committee to escalate issues to.

133. In the Panel’s judgement, throughout the period of change and re-structure, there was little management assistance for the team leaders. There were some opportunities for meetings, but there was an absence of operational policy direction on key elements of the change to assist the team managers, and not enough detail provided to assist with effective implementation.

134. The Panel considered that the leadership during the restructuring period was inexperienced. Although the Registrant was an experienced Social Worker, he had only been in his new role as manager for this team for a short time. Colleague A’s perception was that the Registrant and another team manager had limited experience of learning disabilities.

135. The Panel considered that there was a certain level of volatility within the teams and for the individual personnel in the teams. There had been new teams created, with staff changing teams or leaving, and a reliance on agency staff. There was also a noticeable increase in the workload assigned to the teams. Colleague A said that she was given the additional responsibility to conduct 60 reviews (out of an additional 200) of cases of existing service users in light of the implementation of the Care Act, which the team had to complete between December 2015 and March 2016. The Registrant also had extra duties, such as the Shared Lives Initiative, which he had been responsible for prior to becoming a team leader and which had not been re-assigned, as well as his own caseload and managing his team.

136. Notwithstanding this context, the Panel considered misconduct in respect of each particular.

137. In respect of particular 2, Service User B was a vulnerable young woman, who had allegedly been subjected to a sexual assault, and an ongoing risk to her had therefore been identified. In the Panel’s judgement, the Registrant, as manager, should have ensured that the case progressed to Level 3 safeguarding and convened a strategy meeting to share the information and decide on a course of action regarding her protection against possible sexual exploitation. In omitting to ensure that such a meeting was held, the Registrant fell below the standards expected of a Social Worker, and this was sufficiently serious as to amount to misconduct.

138. In respect of particular 3, the Panel had regard to the context in which this occurred, and in particular, that this was a case which was not progressing to Level 3 safeguarding. There had been no criticism of the decision itself not to progress to Level 3 safeguarding. The Registrant acknowledged that he had forgotten to update the care agency, which would have ensured that they were fully involved and aware of any risk management plans going forward. However, the Panel did not consider that this oversight was sufficiently serious as to amount to misconduct.

139. In respect of particular 4, the Panel considered that the sub-particulars could be appropriately categorised into three groups, namely:

• where a strategy meeting was not held in circumstances in which the safeguarding issues were such that one should have been held;

• where a strategy meeting was held, but no corresponding Level 3 safeguarding form was completed on CareFirst; and

• where a strategy meeting was not held, but the safeguarding issues did not require a meeting to be held.

140. The Panel was of the view that sub-particulars 4(a) and 4(b) fell into the category in which no strategy meeting was held but the safeguarding issues identified were such that a strategy meeting was required. The strategy meetings would bring together a number of professionals and agencies with responsibility for safeguarding the service user, and would task the relevant professionals with ongoing responsibilities and actions in order to safeguard the service user. In the Panel’s view, failing to convene and hold a strategy meeting in such circumstances was sufficiently serious as to amount to misconduct.

141. The Panel was of the view that sub-particulars 4(c), 4(d), 4(e) and 4(f) fell into the category in which a strategy meeting was held but no corresponding Level 3 safeguarding form was completed on CareFirst. The Panel considered that these were examples of poor practice on the part of the Registrant, but neither individually nor cumulatively were they serious enough to cross the threshold into misconduct. In reaching this conclusion, the Panel considered that the meetings were held, the relevant professionals and agencies were present, and decisions were made in respect of ongoing safeguarding for the service users.

142. The Panel was of the view that sub-particular 4(g) fell into the category in which the safeguarding issues were not such as to require a strategy meeting to be held. In the Panel’s judgement, the risk had been assessed and managed, and the outcome had been documented. The Panel did not consider that this amounted to misconduct.

143. In respect of particular 6, the Panel considered that the Unit’s Policy placed a duty on the Registrant, as a manager, to report the case of Service User E’s unexplained bruising while in supported living provided by an agency. In the Panel’s view, the evidence indicated that the agency had started to keep daily body charts of bruising, as this was not the first occasion that unexplained bruising had occurred, and this therefore raised a concern about institutional or organisational abuse. The Registrant had not followed the Policy, which was designed to ensure the protection of service users against abuse by paid workers or in an institution such as supported living. In the Panel’s judgement, the Registrant’s failure to liaise with the Unit in accordance with the Policy was sufficiently serious as to amount to misconduct.

144. In respect of particular 9(a), the Panel considered the context of the Registrant’s omission to advise Colleague A to carry out safeguarding procedures in respect of Service User M and limiting his advice to just carrying them out in respect of Service User M’s mother. The Panel had regard to the circumstances and the fact that there was already a plan in place for Service User M to move out of her mother’s home and be placed in permanent supported living within two weeks, and multiple agencies were involved with the family. In the Panel’s judgement, the consensus of the evidence was to the effect that the risks for Service User M, both residential and financial, were being managed. In these circumstances, the Panel was not of the view that the omission was sufficiently serious as to amount to misconduct.

145. In respect of particular 9(b), the Panel considered that the Registrant had failed to recognise the seriousness of the safeguarding issues in respect of Service User N. The GP had provided a significant amount of medical information in respect of Service User N, including the impact of his self-neglect on his health and prior hospital admissions. Whilst it was clear to the Panel that the state of Service User N’s home was also of concern, the Registrant had incorrectly focused on this in his advice. In the Panel’s judgement, the level of information provided by the GP raised safeguarding issues which should have caused the Registrant to start Level 1 safeguarding procedures. The Panel concluded that his failure to do so was sufficiently serious as to amount to misconduct.

146. In respect of particular 10, the Panel considered collectively the Registrant’s failure to authorise the minutes in a timely manner or at all. The Panel considered that the responsibility of authorising the minutes of safeguarding strategy meetings was an essential role of a manager. Signed minutes are a formal record of a meeting, the purpose of which is to document the action plan for different agencies involved with the service user and ensure their safety. The signed and authorised minutes also provide the accountability for actions taken by the authorities in respect of service users. In the Panel’s judgement, the Registrant’s failure to sign and authorise the minutes of the four strategy meetings, in respect of four service users, was sufficiently serious as to amount to misconduct.

147. The Panel was of the view that the Registrant’s failures had breached the following HCPC Standards of Conduct, Performance and Ethics:

1 - you must act in the best interests of service users;

10 - you must keep accurate records.

148. The Panel was of the view that the Registrant’s failures had breached the following HCPC Standards of Proficiency for Social Workers:

1.1  - know the limits of their practice and when to seek advice or refer to another professional

1.2 - recognise the need to manage their own workload and resources and be able to practise accordingly

10.1 - be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines

10.2 - recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines

149. Accordingly, the Panel found misconduct in respect of particulars 2, 4(a), 4(b), 6, 9(b), 10(a), 10(b) 10(c) and 10(d).

Decision on Impairment

150. The Panel had regard to the HCPTS Practice Note on “Finding that Fitness to Practise is ‘Impaired’” and, in particular, the two elements of impairment, namely the ‘personal component’ and the ‘public component’.

151. The Panel first considered the ‘personal component’.

152. The Panel considered that during the Registrant’s time as a manager, when the Council was undergoing such great re-structuring, he became overwhelmed by the workload, and this had not been picked up by his senior managers, including DF. In his interview in 2016, the Registrant said that he had reflected over the previous week and had identified that he had been experiencing a level of fatigue which meant that, at times, he did not keep up with work that needed to be done, and was prioritising the immediately demanding cases. The Panel considered that he had had opportunities to seek support at the time and did not do so, nor did he express concerns about his workload in supervision.

153. In his ‘Amendments, Clarifications and Additions’ document signed by him on 21 March 2016, the Registrant said that he did not find it easy to say but he had believed he could work well without support and had not sought support. He said: “I recognise that I might have been working below my own expectations. I am not offering excuses, just mitigation and explanation”. The Panel considered that the Registrant had shown insight into his failings during the investigation in recognising his own reluctance to seek support at the time.

154. In further considering insight, the Panel had regard to the observations of the Registrant’s manager, DF. In the Management Report that DF had compiled, he had recorded: “I would also comment that [the Registrant] has been open and honest throughout this investigation. During the interviews I conducted with [him] he was obviously very familiar about the cases I questioned him on and had good knowledge on them”. In evidence to the Panel, DF said: “[The Registrant] was shocked, totally shocked initially, he was very open when I questioned him about the cases. I think he genuinely does care about the work he was doing. It clearly had a big effect on him. When I was questioning him ... he recalled each and every service user I questioned him about in quite a lot of detail, without reference to Care First ... [the Registrant] had a very good knowledge of those cases, which made it even more strange that all these mistakes and errors had been made...". In light of this, the Panel concluded that the Registrant had shown both insight and remorse into his failings.

155. The Panel was of the view that all of the Registrant’s failures were easily capable of remediation. However, he has not provided any information to the Panel to demonstrate that he has, in fact, remediated his practice. It has no information about his current circumstances, whether he has kept his knowledge and skills up-to-date, whether he has undertaken relevant training or courses, or whether he has further reflected on his failings since he left the Council. In the absence of such information from the Registrant, the Panel was unable to conclude anything other than that there remained a risk of repetition of those failures by the Registrant.

156. Overall, and primarily driven by a lack of information from the Registrant as to his current circumstances and whether there has been remediation, the Panel concluded that in respect of the personal component, the Registrant’s fitness to practise is currently impaired.

157. The Panel went on to consider the ‘public component’.

158. In this regard, the Panel kept in mind the protection of the public, in particular service users; maintaining public confidence in the profession; and declaring and upholding proper standards of conduct and behaviour. The Panel considered that in the absence of remediation, there remained a risk to service users, which, in turn, would have a detrimental impact upon public confidence in the reputation of the profession. Therefore, in the Panel’s judgement, a finding of current impairment was required in order to maintain public confidence in the profession, as well as to reassure the public that the standards required of a Social Worker charged with the responsibility of safeguarding vulnerable service users were being upheld. Accordingly, in respect of the ‘public component’ the Panel concluded that the Registrant’s fitness to practise is currently impaired.

Preliminaries at Resumed Hearing (12 April 2018)

159. The Registrant did not attend the reconvened hearing, so the Panel considered service and whether or not to proceed in his absence.

Service

160. On 6 February 2018, the HCPC sent Notice of this resumed hearing by first class post to the Registrant’s registered address. A copy of the Notice was also sent on the same date by email. The Notice contained the required particulars, including time, date and venue.

161. Having heard and accepted the advice of the Legal Assessor, the Panel was satisfied, on the documentary evidence provided, that the Registrant had been given appropriate Notice of this hearing in accordance with the Rules.

Proceeding in absence of the Registrant

162. Ms Manning-Rees, on behalf of the HCPC, applied for the hearing to proceed in the Registrant’s absence. The Panel heard and accepted the advice of the Legal Assessor, who advised that the discretion to proceed in a Registrant's absence should only be exercised with the utmost care and caution.

163. The Panel was informed by Ms Manning-Rees that the Registrant had not been in contact with the HCPC since the case had been adjourned due to lack of time on 18 January 2018. She said that there had been no application for an adjournment by the Registrant.

164. The Panel was satisfied that the HCPC had fulfilled its obligations and taken all reasonable steps to serve Notice on the Registrant in accordance with the Rules.

165. The Panel, having been satisfied that the Registrant had been properly served the Notice by both first class post and email, concluded that the Registrant’s absence was voluntary, thereby waiving his right to attend. He had not communicated with the HCPC since the hearing had been adjourned, nor had he sought an adjournment.

166. The Panel was mindful that the proceedings had been ongoing for a considerable length of time, and it was in the public interest for them to be concluded. In light of the Registrant having waived his right to attend, the Panel considered that the public interest for the hearing to take place outweighed any disadvantage to the Registrant in proceeding in his absence. Decision on Sanction

167. Having concluded that the Registrant’s current fitness to practise is impaired, the Panel went on to consider what would be the appropriate, proportionate and sufficient sanction or other outcome in this case.

168. The Panel accepted the advice of the Legal Assessor. It had regard to the HCPC Indicative Sanctions Policy (ISP) and considered the sanctions in ascending order of severity. The Panel was aware that the purpose of a sanction is not to be punitive, but to protect members of the public and to safeguard the public interest, which includes upholding standards within the profession, together with maintaining public confidence in the profession and its regulatory process.

169. The Panel concurred with the HCPC’s submission that the following were aggravating factors in this case:

• The Registrant had had the opportunity to request help, but had not done so;

• The Registrant had failed to recognise the potential risk of harm in respect of not holding strategy meetings for Service User D (particular 4(a)) and Service User E (particular 4(b)); and

• In this respect, and in relation to his record-keeping responsibilities, the Registrant had failed to discharge his role of manager.

170. The Panel considered that the following were mitigating factors:

• The Registrant had a previously unblemished career over 26 years as a Social Worker and the Panel had not been told of any other previous complaints with the Registrant’s practice;

• The failings had occurred during a period of great upheaval and change at the Council and during a discrete period of time;

• The Registrant’s failings were out of character, his Line Manager having considered that the Registrant had very good knowledge of his cases and cared about the work he was doing;

• There had been significant changes to the operational processes and procedures to be implemented by the newly created Social Work teams;

• The Registrant had been subjected to an extensive workload, which included his own workload, the additional 200 cases the team was responsible for reviewing in light of the Care Act changes, management of the Shared Lives Initiative, and managing his team;

• The team that the Registrant was managing was volatile in respect of staff turnover and use of agency staff;

• A review of the Registrant’s cases by the Council had confirmed that there was no evidence that any service user had come to actual harm;

• The Panel had found that the Registrant had demonstrated insight in recognising his reluctance to seek support at the time.

171. The Panel did not consider the options of taking no further action or mediation to be appropriate or proportionate in the circumstances of this case.

172. The Panel next considered a Caution Order. The Panel acknowledged that it had found, at the impairment stage, that it had no information in respect of the Registrant’s current circumstances, or whether or not there had been remediation, and that in light of this, it had been unable to conclude other than that there remained a risk of repetition. As such, the Panel carefully considered whether this ruled out a Caution Order as an appropriate sanction. The Panel, therefore, carefully assessed what level of risk of repetition remained, and how such a risk may impact on the protection of service users.

173. The Panel considered that it was significant that the Registrant’s Line Manager had considered that the Registrant had a very good knowledge of the cases he was asked about, and cared about his work and role as a Social Worker. The Panel was also of the view that there was an unusual confluence of events existing at the time, including the implementation of the Care Act, the extensive re-structuring of the Adult Services at the Council, the Registrant’s new role as Team Leader, and the volatility of his team in terms of staffing. The Panel concluded that a similar set of circumstances was unlikely in the future. However, the Panel concluded that, even if the Registrant were to find himself in such a situation, he would be in a position to draw from his previous experiences, given the insight he had demonstrated when interviewed as part of the Council’s investigation.

174. The Panel also had regard to that part of paragraph 22 of the ISP which reads: “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”. The Panel was satisfied that many of these features were present in this case. Although the Panel had not been able to rule out a risk of repetition, it was of the view that the particular circumstances of this case were that a Caution Order would keep the Registrant mindful of his practice, which in turn would lessen the potential risk.

175. The Registrant had extensive experience as a Social Worker, and the Panel did not consider that there were meaningful practice conditions which could be formulated in his case. The Panel had also found that the Registrant had shown insight and that his failings were out of character. The Panel therefore did not consider that a Conditions of Practice Order was appropriate in the circumstances of this case.

176. The reality was that the next applicable sanction to consider in the hierarchy of sanctions, if a Caution Order was not appropriate, was that of a Suspension Order.

177. In light of all the above, the Panel concluded that a Suspension Order would be disproportionate and unduly punitive in the particular circumstances of this case.

178. Therefore, the Panel was satisfied that a Caution Order was the appropriate and proportionate response in this case, and was sufficient, for the reasons outlined above, both to protect the public and to address the wider public interest. The Panel determined that the benchmark period of three years was the appropriate length.

Order

That the Registrar is directed to annotate the register entry of Mr Robert David Linton with a caution which is to remain on the register for a period of 3 years from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Mr Robert David Linton

Date Panel Hearing type Outcomes / Status
11/04/2018 Conduct and Competence Committee Final Hearing Caution