Mrs Kelly Coburn

Profession: Occupational therapist

Registration Number: OT43697

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 19/03/2018 End: 17:00 19/03/2018

Location: Radisson Blu Hotel Cardiff

Panel: Conduct and Competence Committee
Outcome: Voluntary Removal agreed

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Allegation

During the course of your employment as an Occupational Therapist with Rhondda Cynon Taf County Borough Council between June 2008 and July 2012 you:
 
1. Did not identify and/or undertake the appropriate assessment based on the service users' presenting condition;
 
2. Did not conduct assessments in an appropriate manner in that you:
 
a) Asked inappropriate and/or irrelevant questions;
 
b) Gave inappropriate and/or incorrect advice;
 
c) [Not Proved]

3. Recommended and implemented adaptations which were not necessary;
 
4. Did not demonstrate a basic level of competency in:
 
a) Problem solving;
 
b) [Not Proved]
 
c) Manual handling;
 
d) [Not Proved]
 
e) Report writing;
 
f) [Not Proved]
 
g) Decision making;

5. Did not communicate properly and effectively with service users and/or carers;
 
6. The matters set out in paragraphs 1 - 5 constitute a lack of competence.
 
7. By reason of your lack of competence your fitness to practise is impaired.

Finding

reliminary Matters

Service of Notice

1. The notice of this hearing was sent to the Registrant at her address as it appeared in the register on 14 February 2018. The notice contained the date, time and venue of the hearing.

2. The Panel accepted the advice of the Legal Assessor, and is satisfied that notice of today’s hearing has been served in accordance with Rule 6(1) of the Conduct and Competence Rules 2003 (the “Rules”).

Proceeding in the absence of the Registrant

3. The Panel then went on to consider whether to proceed in the absence of the Registrant pursuant to Rule 11 of the Rules. In doing so, it considered the submissions of Ms Bass on behalf of the HCPC and also the written correspondence of the Registrant.

4. Ms Bass submitted that the HCPC has taken all reasonable steps to serve the notice on the Registrant. She further submitted that whilst the Registrant has engaged with the HCPC, an adjournment would serve no useful purpose as the Registrant has indicated that she feels that Occupational Therapy is no longer an option for her and implicit in her letter dated 17 February 2018 is an expectation that the hearing proceeds in her absence. Ms Bass reminded the Panel that there was a public interest in this matter being dealt with expeditiously.

5. The Panel accepted the advice of the Legal Assessor. He advised that, if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing, then the Panel had the discretion to proceed in the absence of the Registrant.

6. It was clear, from the principles derived from case law, that the Panel was required to ensure that fairness and justice were maintained when deciding whether or not to proceed in a Registrant’s absence.

7. The Panel was satisfied that all reasonable efforts had been made by the HCPC to notify the Registrant of the hearing. It was also satisfied that the Registrant is aware of the hearing.

8. In deciding whether to exercise its discretion to proceed in the absence of the Registrant, the Panel took into consideration the HCPTS practice note entitled ‘Proceeding in the Absence of a Registrant’. The Panel weighed its responsibility for public protection and the expeditious disposal of the case with the Registrant’s right to a fair hearing.

9. In reaching its decision the Panel took into account the following:
• The Registrant has not made an application to adjourn today’s hearing and implicit in her letter dated 17 February 2018 is an expectation that proceedings today proceed in her absence;
• The Registrant has engaged with the process and has submitted documentation for the attention of the Panel;
• The signed Voluntary Removal Agreement;
• There is a public interest that this substantive order is reviewed before it expires.

10. The Panel was satisfied that the Registrant had voluntarily absented herself from the hearing. There is a distinction between a case where the Registrant is clearly aware of the hearing date, and one where there has been no response from the Registrant. It determined that it was unlikely that an adjournment would result in the Registrant’s attendance at a later date, in the light of the contents of her letter dated 17 February 2018. Having weighed the public interest for expedition in cases against the Registrant’s own interest, the Panel decided to proceed in the Registrant’s absence.

Background

11. Ms Kelly Coburn qualified as an Occupational Therapist in 2005. She previously worked at Gwent NHS trust as a band 5 Occupational Therapist in a mental health setting.

12. On 30 June 2008 Ms Coburn was appointed as a community Occupational Therapist in the Adaptations and Community Equipment Team of Rhondda Cynon Taff County Borough Council (“the Council”).

13. In her role as a Community Occupational Therapist Ms Coburn assessed patients in the community to find out whether they needed any equipment or housing adaptations to assist them with their daily living. She also was expected to take the needs of carers into consideration. The patients Ms Coburn worked with had long term health conditions and/or substantial disabilities.

14. Ms Coburn’s role involved assessing and balancing the risks to service users and their carers in a way that promoted the independence of service users and assisted their carers. Ms Coburn played a part in managing the process by which decisions about the allocation of resources were made. Ms Coburn was required to account for her actions through effective and accurate recording of her assessments, decisions, plans and outcomes.

15. Ms Coburn was diagnosed with a health condition whilst she was at university. She did not disclose her diagnosis on her application form for employment with the Council.

16. At the start of her employment Ms Coburn was allocated MW, senior Occupational Therapist, as her supervisor. As her supervisor MW was responsible for authorising formal assessment documentation and clarifying the clinical reasoning it contained where appropriate. In the first three months of Ms Coburn’s employment MW became aware of issues concerning Ms Coburn’s report writing. These were primarily to do with the structure, spelling and grammar of Ms Coburn’s reports.

17. In a supervision session in October 2008 Ms Coburn disclosed her diagnosis of a health condition to MW. MW shared that information with the Team Manager, Mrs HT. Ms Coburn was referred to the Council’s Occupational Health department who confirmed a diagnosis of a health condition and referred her to the Workstep programme on 21 January 2009. The Workstep programme was designed to offer support to qualifying employees in the workplace. A number of recommendations were made to assist Ms Coburn at that time including the provision of a Dictaphone and read back software.

18. Ms Coburn undertook a range of training during the course of her employment with the Council. In November 2008 she completed modules C, D and F of the “All Wales Manual Handling Passport Training”. The passport training scheme was a national scheme designed to ensure consistency in manual handling training within the NHS in Wales. Module C of the course concerned ‘sitting, standing and walking’; module D ‘bed mobility’ and module F ‘hoisting’.

19. In January 2009 Ms Coburn also received manual handling training delivered by the Council’s own manual handling team.

20. Attempts had been made to introduce Ms Coburn to the manual handling elements of the Occupation Therapist role. She had undertaken a number of manual handling assessments. Ms Coburn made a number of high risk errors whilst on manual handling visits with her supervisor MW and with Mrs TM, a senior Occupational Therapist who oversaw manual handling practice within the team. As a result of these errors from 26 July 2009 Ms Coburn was not permitted to undertake the manual handling elements of her role.

21. In April 2009 concerns were raised by the Council’s Private Sector Housing Unit about the accuracy of Ms Coburn’s recommendations for the installation of stair lifts. Further concerns were raised in June 2009 which included concerns that Ms Coburn often did not complete the necessary functional assessments on visits but nevertheless proceeded to make recommendations for service users.

22. As a result of these concerns it was agreed that MW would check Ms Coburn’s written work before it was uploaded to patient files. Ms Coburn was encouraged to use a camera to assist in her analysis of adaptation requests; provided with a typed summary of the Council’s processes which she could refer to during her assessment visits and advised to contact the team’s advice line if issues arose while she was away from the office.

23. Ms Coburn commenced a period of maternity leave on 11 September 2009. During her absence her cases were allocated to other OTs and further concerns came to light. The Council was required to resolve eight cases where ineffective adaptations had been made on Ms Coburn’s recommendation, many of which needed to be removed. As a result of these matters HT resolved that Ms Coburn should be more closely supervised on her return to work from maternity leave.

24. Ms Coburn returned to work on 28 June 2010. She attended a return to work meeting where she was allocated a new supervisor, Ms JJ and was advised of the concerns that had arisen in her absence. At the return to work meeting Ms Coburn agreed that the key areas of her development needs were: making clinical decisions, critical evaluation of information and assessment. It was agreed that Ms Coburn would benefit from revisiting the COT process from the beginning building up to the full range of Occupational Therapist duties and responsibilities, including manual handling, in the long term.

25. Ms Coburn was willing to participate in the development work. She acknowledged the importance of becoming a fully rounded Occupational Therapist and remained willing and enthusiastic in working towards achieving these goals.

26. Ms Coburn was allocated Ocuppational Therapist assessments in respect of minor works, known as Community Care Worker Assessments, when she first returned to work. These assessments could be undertaken by staff that were not qualified OTs and generally involved less complex cases with minor aids and adaptation referrals.

27. By October 2010 Ms Coburn was working on the less complex Occupational Therapist assessments such as Adapted Housing Assessments. These required full functional assessments and recommendations in respect of future housing having regard to patient needs. All of the cases allocated to Ms Coburn were carefully screened to ensure that she could practise elements of her role without placing patients at undue risk. Ms Coburn continued to work on these less complex cases until she ceased to work as a COT and was redeployed in July 2012.

28. Between June and December 2010 further concerns were raised about Ms Coburn’s practice following a number of observed visits known as L20 observations. The Department’s policy required all Occupational Therapists to undertake two such visits each year where a senior Occupational Therapist would observe them. Issues highlighted on these visits included a lack of knowledge in relation to medical conditions and Occupational Therapist skills, poor listening and interviewing skills and the production of subjective rather than factual functional assessment reports and documents.

29. In December 2010 Ms Coburn and HT held a number of meetings to discuss her work. It was agreed that Ms Coburn could type and edit her assessments before submitting them to her seniors. It was also agreed that observed visits would continue and seniors would intervene only where it was essential to do so.

30. On 2 February 2011 Ms Coburn was referred to occupational health for an urgent assessment of her abilities to undertake the role of COT. Ms Coburn was reviewed by occupational health (“OH”) on 15 February 2011 and referred for a thorough psychological assessment “to try and work out what her capabilities are and what adaptations would be required to keep her in the workplace.”

31. The assessment took place on 15 June 2011 and a report was produced dated 22 June 2011.

32. Following on from this report Ms Coburn was assessed by ‘Access to Work’ on 4 July 2011 and further recommendations as to equipment which might assist her were made.

33. On 19 July 2011 the Council received further OH advice which indicated that on balance some of the performance issues identified in relation to Ms Coburn were due to her underlying medical condition and supported the provision of various pieces of IT equipment to Ms Coburn. By 4 November 2011 the adaptations recommended in the Access to Work assessment had been provided to her.

34. TM attended observational visits with Ms Coburn on 16 and 21 December 2011 and on 11 January 2012. MW attended observational visits with Ms Coburn on 12, 14 and 15 December 2011. As a result of the observations made Ms Coburn was asked to undertake the even less complex work of disabled parking bay assessments.

35. Ms Coburn was on sick leave between 17 January 2012 and 8 February 2012. HT invited Ms Coburn to a meeting in March 2012 under the Council’s Capability procedure to discuss issues relating to her work performance. Her letter identified the issues, which she wished to discuss at the meeting. They were:
• Gathering and recording factual assessment information;
• Clinical judgment/rationale and risk analysis to support recommendations;
• Conduct of the assessment; and
• Imparting accurate information to the client in respect of the grant/adaptation process.

36. HT conducted an informal capability interview with Ms Coburn and her trade union representative on 8 March 2012, an action plan was formulated and a support contract agreed on 14 March and both were put in place with effect from 21 March 2012. It was agreed that Ms Coburn would seek to demonstrate sound clinical reasoning and identify, justify and rationalise clinical decisions made in relation to client needs during the course of observed visits, two way reviews, discussions of recommendations and rationale on assessment reports. There would be constructive critique of the visits, outcomes and reflections. It was also agreed that supervisors would offer support by reviewing referral documents and assessment outcomes before Ms Coburn signed off her reports.

37. TM undertook further observational visits with Ms Coburn on 27 March and 30 April 2012. MW also undertook further observational visits with Ms Coburn on 22 March and 27 April 2012.

38. The action plan was reviewed at a meeting on 30 April 2012. At the meeting HT confirmed that Ms Coburn had not yet met an acceptable competency level in relation to the areas of concern. She told Ms Coburn that she could not consider any request to allocate her more complex cases because of a risk to clients.

39. On 2 May 2012 the informal capability process was suspended at Ms Coburn’s request so that she could consider redeployment. On 15 May 2012 Ms Coburn met with HT, accompanied by her trade union representative and confirmed that she wished to be redeployed. In that meeting Ms Coburn accepted that she was unable to carry out her full role as an Occupational Therapist and confirmed that she had not worked across the full range of Occupational Therapist duties since 2011.

40. On 12 July 2012 Ms Coburn accepted a post as a support worker in the Council’s mental health team. She subsequently brought employment tribunal proceedings against her employer and left her employment with the Council under the terms of an agreed settlement of her claims. She has not worked as an Occupational Therapist since 2012 and is now running a child minding business.

41. On 3 May 2013 the Council’s Occupational Therapist department referred Ms Coburn to the HCPC.

42. The Panel at the Final Hearing found that the particulars of the allegation found proved amounted to a lack of competence, and that the Registrant’s fitness to practice was impaired by reason of her lack of competence. On 1 July 2015, that Panel determined that the appropriate and just sanction was a Suspension Order for a period of 12 months.

43. The Suspension Order was reviewed three times and extended on each occasion, the last review being on 22 September 2017 when the order was extended for a further 6 months.

44. At the last review hearing, the Registrant attended and gave evidence. She told the Panel that she has not worked in an Occupational Therapist role since she resigned in August 2012 and at present intends to concentrate on her career in childcare. However, the Registrant stated that in 2018, once she had completed her Level 5 NVQ Diploma in Childcare, she hoped to return to an Occupational Therapist role in mental health and had made enquiries with regard to an MSc course at Cardiff University and return to work courses.

45. The Registrant stated that she now recognised that she was ‘out of her depth’ when she was working as an Occupational Therapist, and that her lack of competence placed patients at risk and resulted in cost implications for her employer. The Registrant also informed the Panel that she ‘played the victim’ in her last year of employment with the Council and blamed senior management for failing to provide her with training. She stated that she had reflected on her errors and now took full responsibility for her lack of competence.

46. The Registrant informed the Panel that although she has not worked in an Occupational Therapist role since 2012 her confidence and self-esteem has improved. She stated that she is committed to the profession and invited the Panel to replace the Suspension Order with a Conditions of Practice Order.

47. When questioned by the Panel, the Registrant accepted that she had not prioritised a return to Occupational Therapy practice and had not taken any practical steps, to improve her skills and knowledge in that area. In her closing submission, the Registrant stated that she should have been more proactive and invited the Panel to give her another opportunity to demonstrate her commitment to returning to the profession.

48. That panel determined to extend the suspension order for a further six months. The Order is due to expire on 29 April 2018.

Decision

49. The Panel considered the submissions of Ms Bass on behalf of the HCPC. She outlined the background to the allegations and the outcome of the Substantive Hearing in 2015. She submitted that, following representations from the Registrant, and a full review of the case, a Voluntary Removal Agreement was the appropriate method of finalising this case. The HCPC was satisfied that the Registrant fully understood the effect of the Voluntary Removal Agreement and that granting the application would not compromise the protection of the public or have any detrimental effect on the wider public interest. It did not consider that this was a case that only a Striking-Off Order would suffice to protect the public and the public interest.

50. The Panel had sight of correspondence from the Registrant from which it is clear that she no longer wishes to practise as an Occupational Therapist and has no intention of applying for restoration to the HCPC register as a Occupational Therapist in the future.

51. The Panel accepted the advice of the Legal Assessor. He drew the Panel’s attention to the case of Matthew Clarke v The General Optical Council [2017] EWHC 521 (Admin).

52. The Panel considered all of the information and representations by Ms Bass. The Panel has applied its own judgement to the application and also had regard to the HCPTS’s Practice Note on “Disposal of Cases by Consent” and has accepted the advice of the Legal Assessor in this regard.

53. The Panel noted that the HCPC is satisfied that it would be meeting its statutory objective of protecting the public and of the public interest, if the Registrant was permitted to be removed from the Register on similar terms to those which would apply if she were subject to a striking off order under article 29(5) of the Health and Social Work Professions Order 2001.

54. The Panel had before it a Voluntary Removal Agreement that had been agreed between the HCPC and the Registrant and signed and executed by both parties. The Registrant also signed a Declaration that there was no other matter of which the Registrant was aware which might give rise to any other allegation.

55. The Panel firstly considered whether there were any factors that would make it undesirable to allow the this matter to be concluded on the consensual basis set out in the Voluntary Removal Agreement. The Panel has concluded that, given the nature of the allegation, there are no overriding public interest factors that would require this matter to conclude by way of striking the Registrant’s name from the HCPC Register. The Panel was aware that striking the Registrant’s name from the HCPC Register was a possible sanction today as the Registrant has been suspended for more that two years. In coming to its decision, the Panel took the following into consideration:

(a) if the Registrant seeks to return to the HCPC Register at any time in the future, her application would be treated as if she had been struck off as a result of the allegation;
(b) the Registrant has not practiced since 2012;
(c) this is a matter of lack of competence and the Registrant would have to complete and pass a Return to Practice Course before she would be able to practise as an Occupational Therapist again; and
(d) the Registrant has reflected on her practice, and has taken the considered decision to leave the profession and to pursue her new career.

56. In all the circumstances, the Panel is satisfied that both the public and the public interest would be adequately protected by the terms of the agreement reached between the Registrant and the HCPC in as much as the Registrant will henceforth be prevented from practising as a Occupational Therapist and, should she wish to apply to return to the Register, she will be treated as though she had been struck off.

57.Furthermore, the Panel is satisfied that this method of finalising this case is appropriate and proportionate, and which is jointly in the interest of the public, the HCPC and the Registrant. Accordingly the Panel approves the Voluntary Removal Agreement.

58. The Panel is also satisfied that the public interest has been satisfied in that the Registrant has been held to account, that proper standards of practice and behaviour have been declared.

59. In light of the Panel’s determination in relation to the Voluntary Removal Agreement, it is exercising its power to review the Order under Article 30(2) and 30(4) and revokes the current Suspension Order with immediate effect.

 


 

 

Order

Order: The Panel directs that the Suspension Order (the Existing Order) be revoked and approves the VRA on the basis that the Registrar will remove the name of Mrs Kelly Coburn from the Register with immediate effect.

Notes

No notes available

Hearing History

History of Hearings for Mrs Kelly Coburn

Date Panel Hearing type Outcomes / Status
19/03/2018 Conduct and Competence Committee Review Hearing Voluntary Removal agreed
22/09/2017 Conduct and Competence Committee Review Hearing Suspended
21/06/2016 Conduct and Competence Committee Review Hearing Suspended
01/07/2015 Conduct and Competence Committee Final Hearing Suspended