Mr Alexander Fawcett

Profession: Physiotherapist

Registration Number: PH10579

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 01/03/2018 End: 12:30 01/03/2018

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

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as a Physiotherapist at Medway NHS Foundation Trust between 21 January 2015 and 14 September 2015, you:

1. Did not complete your probationary period during which there were concerns regarding:

a. your note keeping, in that you;

i. completed patient notes with illegible handwriting on at least four occasions between March 2015 and May 2015

ii. completed patient notes with spelling errors on at least three occasions between March 2015 and May 2015

iii. did not structure your patient records according to the ‘whole systems’ approach on more than one occasion between March 2015 and May 2015

iv. did not include the patient’s subjective history in the patient’s records on more than one occasion between March 2015 and May 2015

v. failed to demonstrate adequate clinical reasoning in the patient records on more than one occasion between March 2015 and May 2015

vi. problem lists consistently lacked sufficient detail

b. your assessment skills, in that you:

i. during your probation period frequently did not complete comprehensive whole systems assessments;

ii. on at least two occasions in or around April 2015, stated that two unidentified patients chests were clear, yet on assessment both patients had significant loads of sputum

iii. did not link patient history and then adapt your assessment skills accordingly.

iv. on 19 and 20 May 2015 failed to auscultate the lower zones of the lungs of Patient 1 on two occasions and Patient 2 on one occasion.  

c. your use of monitoring during treatment sessions, in that you:

i. on an unknown date in April 2015, removed monitoring equipment from an unidentified patient and instructed the unknown patient to sit at the side of the bed.

ii. on an unknown date and in relation to an unidentified patient, took a blood pressure despite the patient being stable for several days;

iii. on an unknown date and in relation to an unidentified patient, did not reconnect an HDU patient back to the ECG monitoring equipment.

d. your identification of patient problems, in that you;

i. on 19 May 2015, failed to identify the circumstances of when a troponin blood test is required in relation to Patient 1

ii. on 19 May 2015, failed to identify that Patient 1 had metabolic alkalosis

e. your clinical reasoning, in that on 20 May 2015 you used technical terms incorrectly

f. your treatment selection, in that you;

i. on one or more occasion in or around April and May 2015 did not alter treatment plans according to the patient’s needs

ii. did not prepare bed space adequately

iii. did not sufficiently frequently provide patients with exercises for their trunk;

iv.  on 21 April 2015 did not return a patient’s table within reach of an unidentified HDU patient

v. on 21 April 2015 left Oxygen cylinders by an unidentified HDU patient’s bed

vi. on or around May 2015  needed to be prompted regarding the safe placement of a catheter when treating an unknown patient

vii. on 19 May 2015 selected an inappropriate treatment for Patient 1

g. your communication skills, in that you:

i. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient age;

ii. on more than one occasion between March 2015 and May 2015 did not adapt your communication style to patient needs;

iii. on more than one occasion between March 2015 and May 2015 raised your voice unnecessarily to patients;

2. The matters set out in paragraph 1 constitute lack of competence.

3. By reason of your lack of competence your fitness to practise is impaired.

Finding

Preliminary Matters

Application to proceed Private

1. Ms Wills on behalf of the HCPC submitted that those parts of the hearing  that related to the health of the Registrant should be  heard in private. This  application was not opposed by the Registrant. Having taken the advice of the legal Assessor, the Panel directed that whilst the hearing was a public hearing, any matters that related to the health of the Registrant should be received in private.

Background

2. The matters set out in the Allegation above were considered by a panel of the Conduct and Competence Committee on the 1-4 November 2016. The Registrant started work as a newly qualified practitioner in January 2015 and the matters identified in the Allegation arose during a period from January 2015 to September 2015.

3. The Registrant did not attend the Final Hearing, however he had made full admissions of the facts and sent in written submissions. The factual particulars were found proven by the panel with the exception of particular 1(g)(iv). The panel identified that the Registrant’s practice had fallen short in relation to 10 of the 15 Standards of Proficiency for Physiotherapists expected of a practitioner and had made a finding of lack of competence. In the absence of evidence of remediation, the Panel found impairment and imposed a period of suspension of twelve months.

4. At the time of the Final Hearing the Registrant was undertaking a course in dementia care and working as a Band 3 Therapy support worker.

5. The Final Hearing panel set out clearly that it considered that a future reviewing panel may be assisted by the Registrant providing the following:

• Testimonials or references relating to any recent work he has undertaken;

• A reflective piece on his shortcomings that demonstrates insight;

• Evidence of recent training/CPD including CPD portfolio.

• Evidence of remediation of his shortcomings, for example, evidence of his current communication skills with patients and evidence he is able to write legibly;

• Evidence of continued reading/learning specific to current physiotherapy practice.

6. The matter was then reviewed on 27 October 2017

Review on 27 October 2017
 
7. The Registrant did not attend the review hearing and was not represented. The Registrant had applied in writing  for an adjournment.  His grounds were that he needed to give his employer eight weeks notice before being granted time off work.  The HCPC opposed the application. The application was refused.

Decision on impairment by the review panel

8. The review panel first considered whether the Registrant’s fitness to practise was still impaired. It decided that it was. Its reasons were stated as follows;

“The Panel noted that notwithstanding his application for an adjournment, the Registrant had not taken the opportunity, as he had at the Final Hearing, of presenting any written representations. In the absence of any information from the Registrant, other than that he is working in a ‘hospital setting’, there is therefore nothing on which this Panel can assess whether the Registrant has addressed and corrected his lack of competence. There was nothing on which this Panel could make a finding that he is no longer impaired. This being the case, the Panel considered that there remained a need for some form of restriction on the Registrant’s registration.”

Decision on sanction by the review panel

9. Having decided that the Registrant’s fitness to practise was still impaired, the first review Panel proceeded to consider the appropriate sanction. It reviewed all the options available to it and decided that a Suspension Order for a period of 12 months was the appropriate and proportionate order. It explained its reasons as follows;

“As guided by the Legal Assessor the Panel considered the appropriate and proportionate restriction. A Caution Order would provide no service user protection and in the absence of any information that the Registrant had undertaken remediation of the ten areas of his practice which had been found wanting the Panel concluded that this was inappropriate. A Condition of Practice Order was considered inappropriate and impractical as well as insufficient in the current circumstances where there is no information from the Registrant which would assist with drafting any workable conditions.

The Panel has therefore come to the decision that the only appropriate and proportionate order in this instance is a further Suspension Order. The Panel noted that the Registrant had not attended the Final Hearing as he had considered that it would be detrimental to his wellbeing to do so. The Registrant has stated in his adjournment application that he wishes to attend a review. This indicates that the Registrant may now feel able to engage in a further review. The Panel has mentioned above that the Registrant is able to call for an early review of this Suspension Order under Article 30(2). If the Registrant were to do this, it would allow him the opportunity to provide information which had been requested by the Final Panel, and which is set out in the background section of this decision but also to arrange a further review at a date that will accommodate his need to give his employer sufficient notice of absence.

If, however, the Registrant is not yet prepared to demonstrate how he has been seeking to address his competency issues (and this may be inferred from his failure to provide any evidence to date), the Panel considered that he may require some time to adequately address his failings. Therefore, the Panel concluded that the period of suspension should be a further 12 months. If the Registrant should choose to ask for an early review then his case may be reviewed sooner.”

The Registrant’s application to this Panel

10. By a letter dated 23 November 2017 the Registrant requested an early review of the order made on 27 October 2017. He explained why he did not attend the hearing on 27 October 2017. He explained that he would like to present evidence “on how I am addressing and correcting my lack of competence”.

Decision of this Panel

11. The Registrant gave oral evidence, responded to questions and made submissions. In summary he said as follows:

• He relied on the documents that he had produced and which are referred to below. He is currently employed as a static Band 3 Therapy Support Worker on the ITU/Surgical wards at the Queen Elizabeth Queen Mother Hospital.

• That his fitness to practise was not now impaired. In support of this assertion he said that he had addressed the previously identified failings and that his health had substantially improved. He also said that  his present employers provided considerable support. He also relied on the testimonials referred to below. He did however acknowledge that some of the previously identified failings, for example, “clinical reasoning”, could only be fully addressed when he was in employment as a physiotherapist.

• That if contrary to his principal submission the Panel was to hold that his fitness to practise was still impaired, the appropriate order for the Panel to make was a Conditions of Practice Order. He acknowledged that the Conditions imposed on 13 January 2016 on an application by the HCPC for an Interim Order were Conditions which were compatible with his continued employment as a physiotherapist.

12. The Panel saw a number of documents that were produced by the Registrant; they included the following:

• A reflective piece on his shortcomings signed by the Registrant and dated 4 February 2018.

• A number of testimonials and references.

• Evidence of recent training.

• Evidence of remediation of his shortcomings.

• Evidence of continued reading and learning.

13. Ms Wills on behalf of the HCPC  made submissions which were in summary as follows; that the Registrant’s fitness to practise was still impaired. She further submitted that if the Panel concluded that the Registrant’s fitness to practise was still impaired, the nature and duration of the Order was one for the Panel to determine and the HCPC did not seek to take a position on that matter.
14. The Panel has considered all the evidence and submissions that it has received.

15. This Panel heard and accepted the advice of the Legal Assessor

16. This Panel is aware that it has all the powers that are set out in Article 30 [2] of the Health and Social Work Professions Order 2001 [The Order] and which are summarised in the letter dated 01 February 2018 addressed to the Registrant and giving notice of this hearing.

17. This Panel is aware that the process under Article 30 [2] of the Order is one of review and not one of appeal and that its function is to determine whether the Registrant’s fitness to practise is still impaired and if so whether the Suspension Order under review remains appropriate and proportionate or should be varied or replaced by some other order.

Decision on Impairment

18. This Panel has concluded that the Registrant’s fitness to practise is still impaired. The Panel was impressed by the evidence that the Registrant has given to it and by the way in which he responded to questions. It was also impressed by the Registrant’s obvious commitment to his profession and the way that he had addressed many of the previously identified failings. However the Panel noted that the Registrant did acknowledge that some of those previously identified failings could only be fully addressed when he was back in practice. The Panel also noted that none of the testimonials referred to the Registrant’s handwriting.  The Panel concluded that in all the circumstances an Order is still necessary in order to protect members of the public, to maintain proper standards of clinical performance, to sustain public confidence in the profession and in the HCPC as its regulator.

Decision on Sanction

19. Having concluded that the Registrant’s fitness to practise is still impaired, this Panel proceeded to consider what order is appropriate,  and proportionate to protect the public.

20. This Panel has considered all the submissions that it has heard and all the evidence that it has received.

21. This Panel took into account the principles of proportionality balancing the interests of the Registrant with the public interest.

22. This Panel has had regard to the contents of the Indicative Sanctions Policy published by the HCPTS and is aware that sanctions should be considered in ascending order of severity. This Panel is aware  that the purpose of sanctions is not punitive but to protect members of the public and to safeguard the public interest. The latter objective includes maintaining standards within the profession, together with public confidence in the profession and in its regulatory processes.

23. This Panel has concluded that imposing a Caution Order would be inappropriate having regard to the nature and gravity of the matters found proved. Such an Order would not sufficiently protect the public or the public interest.

24. This Panel concluded that in the circumstances that now exist a  Conditions of Practice Order in the terms set out below is the appropriate and proportionate Order to provide protection for members of the public and would safeguard the public interest. In coming to this conclusion the Panel noted that the Registrant accepted that he would be able to work within the context of the Interim Conditions of Practice Order imposed on 13 January 2016. The Panel noted that the Registrant acknowledged that his present employers were supportive and both could and would provide the level of supervision prescribed in that Interim Order. Consequently the Panel has decided to make a Conditions of Practice Order which with a very minor adjustment is in the same terms as the Interim Conditions of Practice Order imposed on 13 January 2016.  

25. This Panel considered that a Suspension Order would not in present circumstances be proportionate. Accordingly the Panel revokes the existing Suspension Order and replaces it with a Conditions of Practice Order. It also notes that a Striking Off Order was not available to it.

26. This Order will be reviewed by another panel before it expires.

Order

The Registrar is directed to annotate the HCPC Register to show that for a period of 12 months from the date that this Order comes into effect you, Mr Alexander Fawcett, must comply with the following conditions of practice:

1. At all times during any employment as a Physiotherapist, you must place yourself and remain under the supervision of a workplace physiotherapist supervisor registered by the HCPC and supply details of your supervisor to the HCPC within seven days of the date of your employment. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must work with your supervisor to formulate a Personal Development Plan designed to address the concerns raised in the allegations including:

• Note Keeping
• Clinical Assessments, Clinical Reasoning, the identification of patient problems, and Treatment Selection
• Use of monitoring of Patients during treatment sessions
• Communication with Patients and Colleagues
• Caseload and Time Management Skills
• Participation in Feedback

3. Within three months of the date you are employed as a physiotherapist, you must forward a copy of your Personal Development Plan to the HCPC.

4. 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.

5. 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.

6. You must provide to the HCPC a report from your supervisor no later than seven days before any review of this interim order detailing the progress you have made towards achieving the aims set out in your Personal Development Plan and in relation to compliance with this Interim Order.

7. 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 as a Physiotherapist;

b. any agency you are registered with or apply to be registered with as a Physiotherapist (at the time of application); and

c. any prospective employer of you as a Physiotherapist (at the time of your application).

Notes

The order imposed today will apply with immediate effect.

This order will be reviewed again before its expiry on 1 March 2019.

Hearing History

History of Hearings for Mr Alexander Fawcett

Date Panel Hearing type Outcomes / Status
01/03/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
27/10/2017 Conduct and Competence Committee Review Hearing Suspended