Ms Anne Margaret Davies
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The following allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 14-16 and 19-20 September 2016.
During the course of your employment as a Social Worker with Worcestershire Health and Care NHS Trust (the Trust) between October 2010 and 14 January 2014, you:
1. Did not consistently update the Trust PBI system in respect of:
a. Care plans; and/or
b. Care plans reviews; and/or
c. Cluster reviews; and/or
d. NHS Care Records System (NCRS) contact;
2. Did not consistently complete care plans within 28 days of allocation, in the cases of:
a. Service User 8; and/or
b. Service User 9; and/or
c. [Not Proved]
3. Did not consistently include sufficient and/or adequate information in care plans in the cases of:
a. Service user 2; and/or
b. Service User 21;
4. Did not consistently complete care plan reviews and/or amend the care plans following care plan reviews in a timely manner in the cases of:
a. Service User 2; and/or
b. Service User 11; and/or
c. Service User 12; and/or
d. Service User 13; and/or
e. Service User 14; and/or
f. Service User 15; and/or
g. Service User 16; and/or
h. Service User 17; and/or
i. Service User 18; and/or
j. Service User 19; and/or
k. Service User 20;
5. Did not consistently maintain sufficiently detailed and/or contemporaneous notes in the cases of:
a. Service User 3; and/or
b. Service User 4; and/or
c. Service User 20; and/or
d. Service User 22; and/or
6. Did not consistently manage and/or appropriately respond to risk related information and/or incidents in the cases of:
a. Service User 3; and/or
b. Service User 8; and/or
c. Service User 21;
7. Did not store confidential information appropriately, in that you kept Service User information or other sensitive documents on and/or in your desk;
8. [Not Proved]
9. Did not consistently manage your timekeeping effectively in relation to appointments with service users in the cases of:
a. Service User 5; and/or
b. Service User 6; and/or
c. Service User 7
10. Did not consistently discharge Service Users in a timely manner in the cases of:
a. Service User 1; and/or
b. Service User 11; and/or
c. Service User 12; and/or
d. Service User 13;
11. The matters described at paragraphs 1-10 constitute misconduct and/or lack of competence.
12. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.
The Panel at the substantive hearing found the following:
Facts proved: 1(a-d), 2(a-b), 3(a-b), 4(a-k), 5(a-d), 6(a-c),7, 9(a-c), and 10(a-d).
Facts not proved: 2(c) and 8.
The panel found the Registrant’s fitness to practise to be impaired and a Suspension Order for a period of 9 months was imposed as a sanction. This decision was reviewed on 13 June 2017 and that panel imposed a further Suspension Order for a period of 12 months.
1. Following advice from the Legal Assessor, the Panel agreed to hear any matters pertaining to the health of the Registrant in private. All other matters were heard in public in the ordinary way.
2. The Registrant is a registered Social Worker. From 2008 she was employed as a Band 6 Case Manager in the Early Intervention Service (EIS), which was part of Adult Mental Health and Child & Adolescent Mental Health Services (CAMHS) at Worcestershire Health & Care Trust (the Trust). EIS provides clinical interventions via a Multi-Disciplinary Team (MDT) for service users aged 14-35 years who have experienced a first episode of psychosis.
3. The proven allegations of misconduct concerned the period of October 2010 to January 2014, during which time, from November 2010 to November 2012, the Registrant was supported through the Trust’s Capability Procedure. In addition, the Registrant’s caseload was reduced from 15 to between 9 and 11 cases. The misconduct related to a wide range of case management issues, and included: the consistent failure to update care plans and reviews; consistent failure to complete and/or amend care plans and reviews; consistent failure to include sufficient information in care plans and in case notes; consistent failure to respond appropriately to risk-related information; consistent failure to liaise with other professionals; and the failure to store confidential information appropriately.
4. The original panel considered that an aggravating feature was the persistance and duration of the Registrant’s failings, leading to the real risk of recurrence. On the other hand, that panel also accepted what it considered to be the strong mitigation of the Registrant’s acceptance of her failings, combined with her history of good service and her proven clinical skills. It considered that the extent and duration of misconduct was too serious to make no order or to impose a Caution Order. A Conditions of Practice Order was determined, at that time, to be unworkable and onerous, and would also not meet the gravity of the situation, which was why the Suspension Order was imposed for 9 months.
5. That panel also indicated what a review panel might consider helpful evidence to demonstrate that the Registrant had gained further insight and remediation. It was suggested that this might be an update from the Registrant about her progress and written and/or oral evidence from an employer (whether voluntary or paid work) in relation to a role similar to social work, in particular to managing a caseload and completing all relevant recording and administration.
6. The review panel, on 13 June 2017, first considered whether the Registrant’s fitness to practise remained impaired or whether all the deficiencies had been sufficiently and fully addressed and remedied. The Panel noted that the Registrant did not contend that this was the case, but that more needed to be achieved. The panel was particularly concerned at the limited progress demonstrated in respect of the Registrant’s gaining of insight into the identified wide-raging deficiencies that had occurred over a period of years. The deficiencies related to fundamental tasks of a Social Worker and the Registrant still displayed limited recognition of the impact on service users of her failure to carry out her responsibilities. In the circumstances, the panel determined that further steps were required and that the Registrant’s fitness to practise remained impaired.
7. The panel therefore went on to consider whether an order remained necessary. The extensive nature of the deficiencies found in the Registrant’s practice combined with the Registrant’s limited insight created, in the panel’s view, the real risk of repetition of the misconduct to the potential harm of service users. The panel therefore determined that a further order was required in order to protect both the public and the public’s confidence in the profession and the regulatory process.
8. The panel moved on to carefully consider whether it was sufficient and proportionate to extend the current period of suspension, or whether the lesser sanction of a Conditions of Practice Order for a further period would be more appropriate. The panel concluded that it could not frame workable conditions of practice because the deficiencies identified are wide-ranging and the conditions required would be far too onerous for an employer. Moreover, conditions of practice could not really address the panel’s main concern in this case, which was the lack of the Registrant’s full insight into her failings and the possible detrimental consequences for service users of those failings.
9. The panel determined that the minimum sufficient and proportionate order would be to extend the Suspension Order for a further period of 12 months upon the expiry of the present Suspension Order. It would be disproportionate to impose a Striking-Off Order given the Registrant’s gaining of some insight, albeit at that time insufficient insight, and her willingness to seek to address and remedy the identified deficiencies.
10. The panel considered that the next review panel might be assisted by
· the Registrant’s personal attendance at the review hearing;
· oral and/or written reflections by the Registrant which demonstrate greater insight into her identified deficiencies and the risk which those deficiencies pose to service users;
· oral and/or documentary evidence of (i) continuing professional development (CPD) and (ii) the maintenance of the Registrant’s skills in social care.
· Relevant references and testimonials, in particular those which directly address the Registrant’s efforts to remediate her identified deficiencies.
11. This Panel has taken into account all the documentation placed before it, which included: a professional reference dated 10 May 2016; a document from the Registrant entitled ‘Report for review of suspension order hearing on 13/06/2017’ dated 26 May 2017; a reference from the Registrant’s employer dated 24 May 2017; a reflective statement from the Registrant dated 27 May 2018; a letter from her current employer, acknowledging that the Registrant has worked for them since 20 November 2016 and is still employed - for company policy reasons they said they were not able to provide a current reference; a certificate for successfully attending Foundation Training on 11 and 25 January 2018; and a certificate indicating the Registrant attended and completed ‘Evidence Based Practice’ training on 31 October (no year was given but the Registrant indicated this was in 2017).
12. The Panel also took into account the submissions made by Ms Hurd on behalf of the Registrant and those by Ms Senior on behalf of the HCPC. The Panel accepted the advice of the Legal Assessor and in reaching its decisions referred to the HCPTS’s Practice Note on ‘Finding Fitness to Practise is Impaired’.
13. The Panel first considered the issue of current impairment. In her reflective statement the Registrant told the Panel that she has thought deeply about her failings which led to her suspension and she accepted that these meant service users were put at risk. She said, “I know that, when there are serious untoward incidents in mental health, including homicide, the enquiries often find that a vital piece of information has not been passed on, leading to inadequate risk assessment and management. I am very grateful that no serious untoward incident took place when I had not done an up to date risk assessment, care plan and notes.” She said that she had made significant improvements in terms of record keeping and communication before she left Worcestershire Health and Care Trust on 14 January 2014. The Registrant outlined how she had maintained her continuing professional development and also detailed her current work as a Support Worker. She concluded by saying, “I am absolutely clear that I do not want to lose my registration and the opportunity to return to social work in the future.” The Registrant added that, “One care plan, risk assessment, set of notes not completed adequately within the expected time frame is a significant failure in my duty of care.”
14. The Registrant gave evidence to the Panel and said she understood and fully accepted the matters that were found proved at the original hearing. She said she accepted that even with her reduced caseload she had failed to do what she was supposed to do. She said that in her reflective piece it sounded like she was quarrelling with the actual description of the allegations, but that was not what she was trying to say. Rather, she was trying to point out that at the time she left Worcestershire she was making really significant efforts to practise as she should have been all along. She said that it would have been good for there to have been some acknowledgement of the changes she had made rather than saying that she did not accept the allegations, which she did.
15. The Registrant also said that each time she failed to do a care plan, risk assessment or make service user notes, she was failing in her duty towards those service users and also giving social work a bad name. She recognised that she was failing in her duty of care towards the service user, their family, other colleagues and the public. She understood that by not providing risk assessments and completing care plans and ensuring they were up to date, things could have gone really badly wrong. It meant that service users might not get the support they needed and in the worst case scenario might have taken their own lives or presented a risk to others. She said she understood the importance of making and maintaining records and candidly said that she must have been a nightmare for her colleagues to work with. She added that if there was no care plan then that would mean a colleague effectively working with one hand tied behind their back because they would not know what issues had been identified or what kind of support the service user needed. She also said that a risk assessment was only as good as one’s efforts to make people aware of it.
16. The Registrant said she considered that her fitness to practise was still impaired but wanted the opportunity to demonstrate that she had learned from her mistakes and that she was keen to return to social work. She felt she would benefit from the support provided by a strict Conditions of Practice Order to ensure she did not make errors or, if she did, then they would be picked up quickly. She acknowledged that she had been provided with support in the past by way of action plans which had not been effective. However, she said she now took matters much more seriously and that was the real difference. She did not want to return to her past work in child protection or her previous NHS role, but rather an area where she could focus on therapeutic work.
17. The Panel took account of the principle set out in Abrahaem v GMC  EWHC 183 (Admin) that there is, in practical terms, a persuasive burden at a review hearing for the Registrant to demonstrate that she has “fully acknowledged why past performance was deficient and through insight, application, education, supervision or other achievement sufficiently addressed the past impairments.”
18. Following the Registrant’s evidence, Ms Senior said that she had taken instructions and the HCPC was now neutral on the question of whether the Registrant’s fitness to practise remained impaired.
19. The Panel was reassured by the Registrant’s acceptance of her failings, the importance of risk assessments, care plans and contemporaneous notes. However, in light of some her answers to Panel questions, the Panel remained concerned about how well the Registrant is able to assess risk.
20. The Registrant also demonstrated insight explaining why she would do things differently and why. The Panel was impressed with her candour in accepting that her fitness to practise remained impaired and that she would benefit from a strict Conditions of Practice Order that allowed her to return to work as a Social Worker. This would allow her the opportunity to demonstrate that she had remedied her earlier failings whilst still providing protection for the public.
21. The Panel considers the Registrant is now demonstrating a greater degree of insight into her failings. It is clear she takes the findings seriously and is keen to be given the opportunity to return to work as a social worker so as to be able to demonstrate that she can be safe to practise. Notwithstanding the much improved insight, the Panel considered the Registrant’s fitness to practise to still be impaired because until she is able to return to practice and demonstrate her fitness to practice, there remains a risk she may repeat the previous failings. This was particularly so given the Panel’s concerns about her ability to adequately assess risk.
22. The Panel then considered what sanction was both appropriate and proportionate in all the circumstances and, in doing so, considered the HCPC Indicative Sanctions Policy. The Panel noted that the Registrant had now been suspended for 21 months and that it was difficult for her to properly demonstrate remediation until able to practise as a Social Worker. Having heard from the Registrant the Panel was satisfied that Conditions of Practice could now be formulated that would adequately protect the public and allow the Registrant to return to practice in a meaningful way. The Registrant had indicated a strong desire to return to practice and that she was committed to resolve the failings which brought her before this tribunal. The Order will be for 18 months to allow the Registrant sufficient time to fully comply with them and demonstrate that she has remedied her practice.
The Registrar is directed to, on the expiry of the current Suspension Oder, annotate the Register to show that, for a period of 18 months from the date that this Order comes into effect (“the Operative Date”), you, Ms Anne Margaret Davies, must comply with the following conditions of practice:
1. You must confine your professional practice to the private, charitable or voluntary sector and not work for any statutory social work services.
2. You must not undertake any out-of-hours work or on-call duties, unless there is a manager available for advice should it be needed.
3. You must work with a supervisor to formulate and maintain a Personal Development Plan designed to address the deficiencies in the following areas of your practice:
a) risk assessment;
b) care plans;
d) case management;
e) record keeping.
4. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.
5. You must meet with your supervisor on a fortnightly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.
6. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.
7. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
8. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
9. You must inform the following parties that your registration is subject to these conditions:
A. any organisation or person employing or contracting with you to undertake professional work;
B. any agency you are registered with or apply to be registered with (at the time of application); and
C. any prospective employer (at the time of your application).
The Order imposed today will apply from 18 July 2018.
This Order will be reviewed again before its expiry on 18 January 2020.
History of Hearings for Ms Anne Margaret Davies
|Date||Panel||Hearing type||Outcomes / Status|
|15/06/2018||Conduct and Competence Committee||Review Hearing||Conditions of Practice|
|13/06/2017||Conduct and Competence Committee||Final Hearing||Suspended|
|14/09/2016||Conduct and Competence Committee||Final Hearing||Suspended|
|08/06/2016||Conduct and Competence Committee||Final Hearing||Hearing has not yet been held|