Mr Simon White
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During the course of your employment as a Physiotherapist with Bristol Community Health, between August 2012 and 23 January 2015;
1. In relation to Patient A you:
(a) Required prompting to ensure all the brakes on the commode were engaged prior to transferring Patient A to the commode;
(b) Did not plan for and/or show evidence of planning for Patient A’s discharge;
(c) Did not fully complete the notes of your session with Patient A on 23 June 2014;
(d) Did not develop exercise programmes for Patient A which were patient-specific and/or goal focused.
2. On 13 August 2014, whilst completing an initial physiotherapy assessment with an amputee patient, Patient B, you:
(a) Did not ensure that the surrounding area was safe and unobstructed prior to requesting Patient B to wheel themselves to the parallel bars.
(b) Did not move and/or prompt the patient to move the foot plate on the patient’s wheelchair before he stood up.
(c) Did not move the stump plate before allowing Patient B to transfer from the wheelchair to the parallel bars.
(d) Did not move the stump plate before allowing Patient B to sit back down.
3. On the 19 August 2014, whilst conducting a manual handling assessment and an initial assessment with Patient C who had a revision of a total hip replacement you;
(a) Did not notice that the chair available to Patient C was too low which increased the risk of Patient C’s hip dislocating.
(b) Positioned Patient C at the edge of the bed thereby increasing the risk of falling.
(c) Did not obtain full details regarding Patient C’s multiple sclerosis.
(d) Conducted limited objective assessments of Patient C and did not record the clinical reasoning as why this was the case.
4. On 20 August 2014 whilst assessing Patient D who was recovering from a fractured hip, you:
(a) Did not adequately observe Patient D undertaking a hip extension exercise thereby:
(i) Allowing her to perform the exercise incorrectly;
(ii) Leaving her at risk of hitting her head on the wall;
(b) Did not seek and/or record information regarding Patient D’s previous falls;
(c) Did not and/or had to be prompted to carry out a cognitive assessment of Patient D;
(d) Did not carry out a balance assessment;
(e) Did not plan and/or record planned treatment in relation to Patient D;
(f) Did not show evidence of clinical reasoning in relation to the patient’s risk of falling;
(g) Did not, without assistance, notice and/or record that Patient D’s left leg caused them the most difficulty with mobility;
(h) Did not, without assistance, record and/or analyse Patient D’s co-morbidities;
(i) Did not complete clear and/or comprehensive patient records regarding the range of motion in both of Patient D’s legs.
5. Assessed Patient E’s outdoor mobility on 30 October 2014, and you:
(a) Did not discuss the assessment with the patient and/or provide her with instructions prior to commencing the assessment;
(b) Did not prompt the patient to check for oncoming traffic before commencing a road crossing, which led to a colleague standing in the middle of the road to slow oncoming traffic;
(c) Did not record the incident referred to above in the patient notes.
6. On 3 November 2014, whilst attempting to carry out a sliding board transfer from a bed to a wheelchair in relation to Patient F you did not:
(a) Place the sliding board in the correct position underneath the patient in order to complete the transfer from the bed to wheelchair;
(b) React appropriately when Patient F became fatigued and/or moved too close to the end of the bed thereby increasing the risk of falling;
(c) Provide instructions to the rehabilitation worker assisting you with the transfer.
7. The matters set out in paragraphs 1-6 constitutes lack of competence.
8. By reason of your lack of competence your fitness to practise is impaired.
The Panel at the substantive hearing found the following:
Facts proved: 1 (a), 1 (b), 1 (c), 1 (d), 2 (a), 2 (b), 2 (c), 2 (d) 3 (a), 3 (b), 3 (c), 3 (d), 4 (a), 4 (b), 4 (c), 4 (d), 4 (e), 4 (f), 4 (g), 4 (h), 4 (i), 5 (a), 5 (b), 5 (c), 6 (a), 6 (b), 6 (c).
Facts not proved: None
Grounds: Lack of competence
The panel found the Registrant’s fitness to practise impaired and a Suspension Order of 12 months was imposed as a sanction. This decision was reviewed on 28 November 2017 and that panel imposed a further Suspension Order of 6 months.
1. The Panel had before it evidence that on the 6 April 2018 the Registrant was informed of the date and venue of the hearing and that by way of an amended notice letter dated 9 April 2018 the change of timing of today’s hearing. These notices had been sent by the appropriate postal means and to the Registrant’s registered address and also by email. Whilst the Panel is not required to have evidence of successful delivery of the notices it does in fact have before it information from the Registrant that he is aware of today’s hearing.
Proceeding in Absence
2. The Panel noted that at the previous review hearing the Registrant had participated in the hearing on the telephone. The Panel had evidence today that the Registrant did not wish to make verbal submissions and had indicated that his written representations should be taken by the Panel. The Panel appreciated that this was a mandatory review and that time was therefore of the essence. The Registrant had not provided any information that indicated that he would attend at a future date or that there were substantive reasons for his absence such as illness or lack of representation. This being the case, the Panel came to the conclusion that the Registrant had made an informed decision to absent himself and that nothing would be gained by an adjournment. The Panel therefore concluded that the public interest in this matter proceeding in the Registrant’s absence outweighed his right to attend and it decided to proceed with the hearing as scheduled.
3. The Registrant’s employer, Bristol Community Health, brought their concerns about the Registrant’s performance as a Physiotherapist to the attention of the HCPC. Those concerns are encapsulated within the Allegation set out above and which were considered by a Panel of the Conduct and Competence Committee at a hearing held on 14–16 November 2016. All factual matters were found proven and a finding of lack of competence established. The Registrant did not attend the Final Hearing and did not provide any submissions.
4. At the Final Hearing, the Panel imposed a Suspension Order for a period of twelve months.
5. At the review in November 2017, the Registrant presented written representations and participated via the telephone. At that review, the Registrant presented two references relating to his employment with Somerset Partnership in an administrative role. In those representations, the Registrant stated that he had been advised to leave his employment rather than be dismissed. He also identified the underlying reasons for his avoidance behaviour and lack of engagement in the HCPC process at the time of the Final Hearing.
6. The reviewing Panel noted that the Registrant had not practised as a Physiotherapist since January 2015 and that he had not to date undertaken any remedial action or training. The Panel noted that the Registrant had acknowledged that he needed to undergo further training, supervision and mentoring before being able to return to practice. The reviewing Panel accepted that the Registrant had gained some insight into his behaviour; however it was unable to formulate any appropriate or proportionate Conditions of Practice in the circumstances.
7. The reviewing Panel had imposed a Suspension Order for a further period of 6 months. It had also indicated to the Registrant that at the next review a Panel might be assisted if he:
• Participated in person at the further review hearing.
• Produced a reflective piece of writing which focused on the lesson learnt from each of the particulars of the Allegation and his understanding of the impact of his failings on each of the patients concerned.
• Evidenced the steps that he had taken by way of training, CPD and other relevant courses, to address the failings that were identified at the Final Hearing, as well as updating his knowledge and skills.
• Provided testimonials from his current employer.
Evidence and Submissions
8. The Panel today had before it written representations from the Registrant which he requested be taken into consideration in his absence.
9. In those representations, the Registrant described the heath impact he had experienced when practising as a Physiotherapist. He said he is currently working in a very rewarding position with the NHS in a non-clinical Band 4 position which ‘perhaps better suits my aptitude and temperament’.
10. He stated
‘I have fully admitted that there were some legitimate concerns over the standard of my practice as a physiotherapist while employed at the BCH. I have always prided myself on being a ‘gentle and safe’ practitioner. To have concerns of patient safety arising as a result of my practise, no matter my personal circumstances were at the time, strongly suggest that a career in physiotherapy was not the right path for me.’
11. The Registrant stated that he now wished to explore further with the HCPC the possibility of a Voluntary Removal Agreement.
12. In undertaking its task today the Panel is conducting a comprehensive appraisal of the Registrant’s current abilities with a view to establishing whether he is now fit to return to unrestricted practice. The Panel is not undertaking the task of rehearing the matters that had been brought against the Registrant nor going behind the previous findings.
13. This Panel has taken into account all documentation placed before it and has heard and given appropriate weight to the fresh evidence of performance supplied by the Registrant. It has heard the parties’ written and oral submissions and referred to the HCPTS’ Practice Notes.
14. The Panel noted the Legal Assessor’s advice relating to Article 29(6), that a case of lack of competence cannot result in a strike off unless and until there has been a continuous period of suspension in excess of two years. The first substantive Suspension Order was imposed in November 2016 and came into effect in December 2016. The Registrant has therefore today been continuously suspended for a period of 17 months.
15. The Panel noted that at the time of the events the Registrant had only been qualified for a period of two years. He has not worked as a Physiotherapist since January 2015. He has not provided evidence of remedial training or study to address the deficiencies identified in his practice. On 1 May 2018, the Registrant submitted that he wishes to pursue a different career and he has no current intention of undertaking any steps that would assist him with returning to Physiotherapy practice. This evidence supports the Panel assessment that the Registrant’s fitness to practise remains impaired and that some form of restriction remains appropriate for public protection.
16. In assessing which level of restriction to impose the Panel started its deliberations at the bottom of the scale and moved up the range until it found a level which is proportionate in all the circumstance of this case.
17. The Panel discounted taking no further action or imposing a Caution Order as this would provide no public protection, something which was required given the range of failings which had been previously identified in the Registrant’s practice.
18. Again, given the range of failings which required to be addressed the Panel came to the conclusion that any set of Conditions of Practice would have to be so extensive, so restrictive and be supported by evidence of retraining that would in essence equate to a suspension. This being the case, the Panel concluded that a further period of suspension remained the appropriate and proportionate restriction in this case.
19. The Panel noted that the HCPC and the Registrant are considering whether a Voluntary Removal Agreement may be an appropriate route for the Registrant to leave his profession. This Panel takes no view on that matter and it will be for another Panel to determine. It has taken into account, the Registrant’s stated wish to leave his profession. This Panel has decided that a 9 month Suspension Order is practicable and sensible as a future reviewing Panel will, under the Rules then either be able to further suspend or to strike off the Registrant. The cost of an additional periodic review of this Substantive Order will be avoided.
20. This decision to impose a Suspension Order for a period of 9 months of course does not remove from the Registrant the right under Article 30(2) to call for an early review or to present to a future reviewing panel evidence of the steps he has taken to address his previous failings and supporting information in relation to his ability to return to practice.
21. This Panel has not made any recommendations as to what the Registrant should provide a future reviewing Panel. However, should the Registrant have a change of heart and decide to address his current impairment he should refer to the matters identified by the last reviewing Panel in its decision of 28 November 2017.
The Registrar is directed to suspend the registration of Mr Simon White for a further period of 9 months on the expiry of the existing Order.
The Order imposed today will apply from 14 June 2018. This Order will be reviewed again before its expiry on 8 February 2019.
History of Hearings for Mr Simon White
|Date||Panel||Hearing type||Outcomes / Status|
|31/10/2018||Conduct and Competence Committee||Final Hearing||Voluntary Removal agreed|
|08/05/2018||Conduct and Competence Committee||Review Hearing||Suspended|
|28/11/2017||Conduct and Competence Committee||Review Hearing||Suspended|
|14/11/2016||Conduct and Competence Committee||Final Hearing||Suspended|