Mr Rudolph Antonio Coombs

Profession: Social worker

Registration Number: SW22741

Hearing Type: Review Hearing

Date and Time of hearing: 09:00 24/08/2018 End: 11:30 24/08/2018

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

During the course of your employment as a Social Worker by the London Borough of Newham, you:

1. Between December 2010 and July 2013, you were the designated care co-ordinator for Service User A, and you:

(a) Acted outside your scope of practice, in that you:

(i) Allowed London Borough of Newham and/or East London Foundation Trust headed paper to be used for Service User A's personal correspondence;

(ii) Corresponded with external parties on Service User A's behalf;

(iii) Allowed correspondence concerning Service User A's court case to be sent directly to you at your work address;

2(a) Did not adequately analyse and/or demonstrate your analysis of the potential impact of legal proceedings on Service User A’s physical and/or mental well-being.

2(b) As a result of paragraph 2(a) above your mental health assessment of Service User A was inadequate. 

3. The matters described in paragraphs 1-2 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Proof of Service

1.The Panel was provided with a signed certificate as proof that the Notice of Hearing had been posted on 25 July 2018 by first class post, to the address shown for the Registrant on the HCPC register.  The Panel was satisfied that Notice had been properly served in accordance with Rule 3 (Proof of Service) and Rule 6 (date, time and venue) of the Conduct and Competence Committee Rules 2003 (as amended). 
 
Proceeding in Absence

2.Ms Wills, on behalf of the HCPC, made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to the file note, dated 25 July 2018, which recorded a telephone discussion between the Registrant and the HCPC. The note records that the Registrant, ‘stated that he won’t be attending the review hearing on Tuesday 24 August as has no interest in continuing in Social Work at all and he finds the process stressful. “[The HCPC] clarified that there was an error in the first NOH and that the hearing is on Friday 24 August and a corrected NOH was sent today”. She also referred the Panel to an email from the Registrant’s legal representative dated 23 August 2018, which stated, ‘We are aware a review hearing of the suspension order is to take place on Friday 24th August. Please be aware that [the Registrant] will not be present nor will any representative.… [The Registrant] has clearly instructed that he no longer wishes to practice as a social worker and would like to be removed from the HCPC register.’ 
 
3.The Panel was advised by the Legal Assessor and followed that advice. The Panel also took into account the guidance as set out in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
 
4.The Panel determined that it was fair, reasonable and in the public interest to proceed in the Registrant’s absence for the following reasons:
 
a)The Panel noted that the Registrant made it clear during his telephone discussion with the HCPC on 25 July 2018 and through his legal representative that he would not be attending the hearing. There was no indication that the Registrant had changed his mind. In these circumstances, the Panel was satisfied that it was reasonable to conclude that the Registrant had chosen not to engage with these proceedings. Therefore, the Panel was satisfied that the Registrant’s absence was deliberate and demonstrated a voluntary waiver of his right to be present.
 
b)There has been no application to adjourn. Therefore, re-listing this review hearing on an alternative date would serve no useful purpose.
 
c)The Panel acknowledged that there may be a disadvantage to the Registrant in not being present to make oral submissions with regard to his current fitness to practise. However, the Panel noted that the Registrant was informed during the telephone discussion with the HCPC on 25 July 2018, that he could provide written submission or attend by telephone. The file note indicates the Registrant stated that he would discuss the matter with his union representative. However, to date no written representations have been provided and no request has been made to attend by telephone.
 
a) As this is a mandatory review hearing there is a strong public interest in ensuring that it is considered expeditiously. It is also in the Registrant’s interest that this review is considered as soon as possible.

Background
 
4.The Registrant is a registered Social Worker. He commenced employment with London Borough of Newham on 19 July 2010. At the time of the relevant events, he was seconded to East London Foundation Trust and was working within an integrated Community Mental Health Team. 

5.On 20 August 2013, the HCPC received a referral from London Borough of Newham regarding the Registrant. Their concerns related to the Registrant’s conduct in respect of Service User A’s case. The Registrant was the designated Care Co-Ordinator for Service User A and Service User A was pursuing an action in the High Court. In particular, the referral raised concerns that the Registrant had acted outside of professional boundaries by acting in a manner that could be construed as performing the duties of a legal representative for Service User A. This included corresponding with external parties on Service User A’s behalf, allowing correspondence regarding Service User A’s court case to be sent directly to the Registrant at his work address, and using London Borough of Newham and East London Foundation Trust headed paper for Service User A’s personal correspondence. As a result, London Borough of Newham were concerned that the Registrant had gone beyond his role which was to provide emotional and moral support during the court proceedings. 

6.The London Borough of Newham was also concerned that the Registrant, although having maintained that Service User A had mental capacity to fully participate in the court proceedings, did not formally test this using the prescribed framework under the Mental Capacity Act 2005. This was despite concerns as to Service User A’s capacity being raised by legal professionals and the courts and despite Service User A experiencing bouts of physical and psychiatric ill health during the three year period of the court proceedings. 

7.Correspondence the HCPC received from London Borough of Newham also indicated that Service User A’s previous barrister had informed the Registrant of the weaknesses of Service User A’s case, its likelihood of failing and the likelihood that this would incur costs to Service User A. However, when Service User A de-instructed her barrister, the Registrant failed to follow through on management instructions to arrange legal representation for Service User A.

8.Service User A’s claim was ultimately struck out by the High Court and she was ordered to pay the costs of the defendant. Due to the Registrant’s involvement in the proceedings, the Court also granted the defendant permission to apply for a third-party costs order against the Registrant and East London NHS Foundation Trust.
 
9.Following a disciplinary hearing on 9 July 2014, the Registrant was summarily dismissed for gross misconduct. However, he successfully appealed the decision on 24 September 2014, when it was decided he should be re-instated and issued with a final written warning for a period of 24 months.
 
HCPC Submissions

10.Ms Wills, on behalf of the HCPC, outlined the history of this case and provided the Panel with an update. 

11.Ms Wills informed the Panel that the HCPC is currently investigating another allegation ‘[the second case’] which relates to an incident[s] in 2015. She stated that a panel of the Investigating Committee has determined that there is a case to answer with regard to the second case. However, the preparation of that matter remains at an early stage. Ms Wills referred the Panel to the telephone discussion which took place between the HCPC and the Registrant on 25 July 2018, in which the Registrant was informed that ‘in order to remove him from the Register voluntarily he would have to admit the second allegation against him as that has been referred to final hearing (sic).’ She stated that the Registrant has indicated that he cannot recall the detail of the second case and therefore it is unlikely that he will be able to admit the allegation. Ms Wills informed the Panel that the HCPC is actively considering a way forward.
 
12.Ms Wills reminded the Panel of the findings made at the substantive hearing in August 2017. She drew to the Panel’s attention the absence of any evidence of insight or remediation and submitted that as a consequence the Registrant’s fitness to practise remains impaired. She further submitted that the current Suspension Order should be extended for a period of 12 months to provide time for the outstanding issues to be resolved.

Panel’s Approach 

13.In undertaking this review, the Panel took into account the documentary evidence and the submissions from Ms Wills on behalf of the HCPC. 

14.The Panel accepted and applied the advice it received from the Legal Assessor as to the proper approach it should adopt. In particular that:

•The purpose of the review is to consider the issue of impairment based on the previous panel’s findings of fact, the extent to which the Registrant has engaged with the regulatory process, the scope and level of his insight and the risk of repetition.

•In terms of whether his previous misconduct has been sufficiently, and appropriately remedied, relevant factors include, whether the Registrant:
 
(i)fully appreciates the gravity of the previous panel’s finding of impairment;
(ii)has maintained his skills and knowledge;
(iii)is likely to place service users at risk if he were to return to unrestricted practice.
 
•The Panel should have regard to the HCPC Practice Note: Finding that Fitness to Practise is impaired and must take account of a range of issues which, in essence, comprise two components: 
 
(i)the ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and 
 
(ii)the ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession. 
 
•It is only if the Panel determine that the Registrant’s fitness to practise remains impaired, that the Panel should go on to consider sanction by applying the guidance as set out in the HCPTS Indicative Sanctions Policy (ISP), and the principles of proportionality which require the Registrant’s interests to be balanced against the interests of the public.

15.The Panel noted that the Registrant had not provided any of the evidence the substantive hearing panel indicated would be of assistance for the purposes of this review.
 
16.The factual findings, as determined by the panel at the substantive hearing, relate to serious failings with regard to the Registrant’s engagement and interaction with Service User A which persisted for a significant period of time.  The previous panel noted that the Registrant that may have genuinely believed he was acting in Service User A’s best interests in assisting her with the litigation, but he did not appear to appreciate that, in doing so, he was acting outside his role as a Social Worker. This Panel noted that the role of a Social Worker necessarily involves identifying and maintaining appropriate personal and professional boundaries and the findings made at the final hearing indicates that in respect of Service User A the Registrant was unable or unwilling to maintain these boundaries.
 
17.As the Registrant has chosen not to engage with the review hearing there was no evidence before the Panel that he recognises the seriousness of his misconduct, or the impact on service users, nor has he demonstrated that he has taken any steps towards remediation. In the absence of any positive evidence of insight and remediation, the Panel was satisfied that there has been no material change in circumstances, since the Order was imposed. Therefore, the risk to service users and, as a consequence, the risk of repetition remains. Given the ongoing risk to the public, the Panel concluded that public trust and confidence would be seriously undermined if a finding of impairment was not made. Therefore, the Panel was led to the inevitable conclusion that, the Registrant’s fitness to practise remains impaired on the basis of both the personal and public components.   

18.Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what sanction, if any, to impose.

No Action

19. The Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s misconduct which remains un-remediated to take no action on his registration would be inappropriate. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.

Caution Order

20.The Panel went on to consider a Caution Order. As the Registrant demonstrated very limited insight into his misconduct at the final hearing and has not provided any evidence that his insight has developed during the intervening period, the Panel concluded that a Caution Order would not be appropriate. The Panel also took the view that in the absence of remediation, and whilst the risk of repetition remains, a Caution Order would be insufficient to protect the public and meet the wider public interest.

Conditions of Practice Order

21.In considering conditions of practice the Panel took into account paragraph 33 of the ISP which states:

‘Conditions will rarely be effective unless the registrant is genuinely committed to resolving the issues they seek to address and can be trusted to make a determined effort to do so. Therefore, conditions of practice are unlikely to be suitable in cases:
 
•where the registrant has failed to engage with the fitness to practise process, lacks insight…; 
•where there are serious or persistent overall failings;..’

22.The Panel took the view that the Registrant appears unwilling to provide the information and evidence that was suggested by the substantive hearing panel. Although the Panel acknowledged that the Registrant’s failings are potentially capable of being remedied, in the absence of new information from the Registrant, there was no indication that the Registrant is committed to addressing the issues which led to the previous findings of impairment. In these circumstances the Panel could have no confidence that he would comply with a Conditions of Practice Order, even if suitable conditions could be formulated. The Panel was aware that the suggestions made by the previous panel are only indicative and do not have any binding authority, unlike conditions which require compliance. However, both involve willingness on the part of the Registrant and a determined effort. In the absence of any evidence that the Registrant is willing and able to remediate his previous misconduct the Panel concluded that there were no conditions it could devise which would be appropriate, workable and measurable.

Suspension Order

23.The Panel next considered extending the current Suspension Order for a further period. The Panel noted that a Suspension Order would prevent the Registrant from practising during the extended suspension period, which would therefore protect the public and the wider public interest. The Panel also noted that the Registrant stated in his telephone discussion with the HCPC on 25 July 2018, that he has no intention of returning to practice as a social worker and indicated whilst discussing the second case that he would be willing to enter into a Voluntary Removal Agreement (VRA).  The Panel took the view that the second case was only relevant to this review in that it explained why the discussions with regard to a VRA could not be progressed, as it is not possible to consent to voluntary removal whilst allegations remain outstanding. However, the Panel’s focus for the purpose of this review was to consider the appropriate sanction to impose and, given the circumstances, it had to balance the merits of a Suspension Order against the merits of a Striking Off Order.
 
24.The Panel took into account paragraph 41 of the ISP which states, 

‘If the evidence suggests that the registrant will be unable to resolve or remedy his or her failings then striking off may be the more appropriate option.’ 

25.As the Registrant has not engaged with the review process the Panel was unable to assess to what extent his desire to be removed from the Register was influenced by the second case. The Panel noted that the Registrant’s previous misconduct is remediable and appears to have been motivated by good intentions. In these circumstances the Panel took the view that the Registrant should be given a final opportunity to consider carefully the decision of the final hearing panel and this Panel and properly focus on the issues that have been identified. The Panel was satisfied that a period of 6 months would be sufficient for the Registrant to demonstrate an appropriate level of insight into his failings and to take the steps required to return to the Register unrestricted. If the Registrant is unable to demonstrate insight within that time frame it is highly unlikely that he will ever be able to do so.  Although this Panel cannot bind a future review a failure to take this opportunity to demonstrate insight and remediation would be likely to result in a Striking Off Order. 
 
26.In concluding that an extended Suspension Order was the appropriate sanction the panel took the view that a Striking Off Order, at this point in time, would be disproportionate as there remains a possibility that the Registrant is willing and able to demonstrate remediation. The extended Suspension Order will be reviewed shortly before expiry. A future reviewing panel is likely to be assisted by the following:

(a)The attendance of the Registrant at the Hearing; 
(b)Evidence that the Registrant has reflected on his shortcomings and taken remedial steps through training and discussion with a senior practitioner to develop his understanding of why his conduct was at fault and how this could have, and did, impact adversely on Service User A. 

27.The Panel recognised that alternatively if the Registrant remains committed to his stated intention to cease practice as a social worker, he may use the intervening period to enter into discussions with the HCPC with regards to a VRA. 

Order

The Registrar is directed to suspend the registration of Mr Rudolph A Coombs for a further period of 6 months on the expiry of the existing order.

Notes

This Order will be reviewed before its expiry.

Hearing History

History of Hearings for Mr Rudolph Antonio Coombs

Date Panel Hearing type Outcomes / Status
24/08/2018 Conduct and Competence Committee Review Hearing Suspended
29/08/2017 Conduct and Competence Committee Final Hearing Suspended
02/05/2017 Conduct and Competence Committee Final Hearing Hearing has not yet been held