Mr Peter D Thorneycroft

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 3 August 2018 by first class post, to the address shown for the Registrant on the HCPC register. The Notice was also sent to the Registrant by email on the same date. 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 & Competence Committee Rules 2003 (as amended).

Proceeding in Absence

2. Having determined that service of the Notice of Hearing had been properly effected, Ms Thompson, on behalf of the HCPC made an application for the hearing to proceed in the Registrant’s absence. 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 HCPC Practice Note “Proceeding in the absence of the Registrant”.

3. 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 was informed by Ms Thompson that there had been no engagement from the Registrant since the investigation stage of the HCPC’s regulatory procedures. In these circumstances the Panel was satisfied that it was reasonable to conclude that the Registrant’s non-attendance was voluntary and therefore a deliberate waiver of his right to attend and his right to be legally represented.

b) The Registrant did not make an application for the hearing to be adjourned and, as there was no written correspondence or verbal communication from him, there was no indication that he would be willing to attend on an alternative date. Therefore, re-listing this substantive hearing would serve no useful purpose.

c) The HCPC has made arrangements for a witness to give evidence during this hearing. In the absence of any reason to re-schedule the hearing the Panel was satisfied that the witness should not be inconvenienced by an unnecessary
 
delay and should give evidence whilst the events are reasonably fresh in her mind.

d) The Panel recognised that there may be a disadvantage to the Registrant in not being able to respond to the HCPC’s case. However, he was given the opportunity to participate in these proceedings, in person or by submitting written representations, and chose not to do so. In these circumstances the Panel concluded that any disadvantage to the Registrant was significantly outweighed by the strong public interest in ensuring that the substantive hearing is commenced and considered expeditiously.

Application to Amend and Proposal to Offer No Evidence

4. At the outset of the hearing Ms Thompson informed the Panel that she did not propose to offer any evidence in respect of Particular 2(b) as there was no criticism of the Registrant’s record keeping in the statement of Witness JE in relation to his assessment of Patient B on 3 February 2016. She further submitted that Particular 3(e) should be amended by replacing ‘2016’ with ‘2015’ and that 4(d)(iv) should be amended by replacing ’20 June’ with ’17 June’.

5. The Panel accepted the advice of the Legal Assessor. The Panel determined that the HCPC’s ‘offer of no evidence’ would be reflected in its findings of fact and was satisfied that the Allegation should be amended as requested as the proposed amendments were minor in nature, corrected a typographical error, avoided ambiguity and more accurately reflected the HCPC’s case. The Panel noted that the Registrant had not been put on notice of the proposed amendments in advance of the hearing. However, the Panel was satisfied that no injustice would be caused to the Registrant as the amendments do not represent a material change to the Allegation nor do they heighten the level of seriousness.

Private Parts of the Hearing

6. During the oral evidence of Witness JE, mention was made of a health condition which was disclosed to her by the Registrant. The Panel determined that to protect the Registrant’s right to a private life any reference to the Registrant’s health
 
condition, should be heard in private and should be excluded from the public record.

Background

7. The Registrant was employed by Birmingham Community Healthcare NHS Foundation Trust (the Trust) as a Band 6 rotational Occupational Therapist. He was employed with the Trust for approximately 16 years before he resigned in June 2016.

8. The Registrant was rotated into the Birmingham Neuro-Rehabilitation Team (“the Team”) in October 2015. His caseload included Service Users with various neurological disabilities. Although this was a new area of practice for the Registrant, there was an expectation that his previous occupational therapy experience provided him with the required transferable skills.

9. Whilst concerns were noted from December 2015, after the Registrant’s settling-in period, a formal capability process was not implemented until April 2016, as the Registrant underwent surgery at the beginning of the year. Witness JE compiled a list for the Registrant setting out the areas of concern in respect of his practice, identifying what he needed to work on and how they would work together to enable him to make improvements. She identified the overarching issues in respect of the Registrant’s practice to be the need to achieve the expected standards of performance regarding:

• Timely documentation;
• Clinical reasoning;
• Clinical knowledge;
• Planning and prioritisation of occupational therapy goals;
• Ability to follow the Team’s procedures.

10. The Performance and Capability Procedure Action Plan dated 21 April 2016, sought to address these areas of concern. Witness JE had set out the agreed actions, how the actions would be addressed and how improvement would be measured. The plan was signed by the Registrant.
 

11. A letter was sent to the Registrant after an initial meeting dated 9 May 2016, in which he was informed that if he did not meet the expected standards of performance by 12 May 2016, the Stage 1 Performance Review would be escalated to Stage 2 of the process.

12. A referral was made to the HCPC on 18 May 2016, and a Stage 2 meeting took place on 1 June 2016. The letter to the Registrant following that meeting stated:

‘Your continued under-performance is having a direct impact on how we are able to deliver the service and is also an additional pressure on your team colleagues.

I offered you the opportunity to comment on the specific examples of under- performance presented.

You stated in response that you would continue to provide the best care for your patients, as perceived by you, and that you would not do anything detrimental during patient input. You commented that you did not feel this process had any purpose as you were leaving the Trust on 30th June...’

13. As the Registrant had not made any improvements at Stage 1 of the capability process, it was duly escalated to Stage 2 of the formal process. The Registrant resigned in June 2016, and therefore the capability process was not progressed.

14. In her witness statement Witness JE stated:

“From the second meeting to the time of his resignation, Peter Thorneycroft did not make any progress, in fact, his behaviour got worse. He became more disruptive at work and if I asked him to do anything or if I monitored him, he became angry towards me. He kept telling me he was leaving and wanted to spend his final few weeks in peace. I reminded him that despite the fact he was leaving, he still needed to meet his professional standards and ensure patients received appropriate assessment and intervention and it did not mean that he could do whatever he wanted to do. On one occasion, I sent Peter Thorneycroft an email asking him about something that had happened with a patient and he told me to mind my own business. This was not professional, and it affected the patient’s care”.
 
Assessment of Witness

Witness JE - Band 7 Occupational Therapist at the Trust

15. Witness JE line managed the Registrant within the Trust from October 2015, when he was rotated into the Team, until June 2016, when he resigned. Witness JE worked with the Registrant three times a week during his rotation as she worked part time. She informed the Panel that she initially supervised the Registrant on a monthly basis. However, as the issues with regard to his practice became more apparent, she subsequently supervised him more regularly.

16.  The relationship between Witness JE and the Registrant appeared to have broken down during the Performance and Capability procedure. However, Witness JE’s oral evidence to the Panel was balanced and overall was consistent with her written statement. Her supervision records were comprehensive and there was no suggestion from her oral evidence that she bore any animosity towards the Registrant. During her oral evidence, she demonstrated a willingness to accept alternative interpretations of the clinical records. Despite the passage of time, Witness JE had a good recall of the events that took place. She did her best to assist the Panel and there was no reason to doubt that she was anything other than a credible and reliable witness.

Decision on Facts

 Panel’s Approach

17. The Panel was aware that the burden of proving the facts was on the HCPC. The Registrant, present or absent, did not have to prove anything and the individual particulars of the Allegation could only be found proved, if the Panel was satisfied, on the balance of probabilities.

18. In reaching its decision the Panel took into account the oral evidence of Witness JE, her witness statement and the documentary evidence obtained from the Trust. The Panel also took into account the oral submissions from Ms Thompson on behalf of the HCPC.
 
Patient A

19. Patient A had suffered a stroke and lived by himself. He was referred to the Team on 22 October 2015, and was allocated to the Registrant on 2 December 2015. Patient A had physical and cognitive problems. Witness JE stated in her witness statement that there were concerns about Patient A’s ability to adjust to his condition and he needed help with getting into a routine with his day to day activities. She described him as being ‘very vulnerable’ because he lacked insight and needed support with practicing day to day activities.

Particular 1(a) – Found Proved

‘On dates between 02 December 2015 and 23 March 2016, in respect of Patient A you:

Did not complete and/or record an initial assessment and treatment plan in a timely manner;’

20. Witness JE informed the Panel in her witness statement and during her oral evidence that the Registrant was required to complete an initial assessment, within the first few sessions with Patient A. She stated that the purpose of the initial assessment was to address the functional activities that the patient can and cannot do. It also considers the patient’s home environment, care, support, and what the patient was previously able to do before and after the presenting problem. She also informed the Panel that the assessment covers physical and cognitive issues such as insight and the patient’s memory. Witness JE stated that the findings of the initial assessment would inform a treatment plan for the patient tailored to their specific needs.

21. The Panel accepted the evidence of Witness JE. The Panel was provided with Patient A’s records and noted that the Registrant initially saw Patient A on 8 December 2015, during a joint visit with a physiotherapist. Thereafter, the Registrant saw Patient A on ten other occasions between 9 December 2015, and 25 January 2016. However, the initial interview paperwork and the treatment plan were not completed until 29 January 2016. The Panel noted that the delayed initial assessment and treatment plan was raised by Witness JE during her supervision sessions with the Registrant on 13 January 2016, and 22 January 2016. The note relating to the session on 13 January 2016, referred to there being ‘no OT paperwork’ for Patient A. In these circumstances, the Panel concluded that the
 
Registrant did not complete the initial assessment and the treatment plan in a timely manner.

22. Accordingly, particular 1(a) was found proved.

Particular 1(b) – Found Proved

‘Did not complete and/or record an adequate assessment of Patient A’s cognitive and/or physical abilities;’

23. Witness JE stated in her witness statement that ‘Patient A had a lot of cognitive problems which were identified when he was initially referred to the Team’. She informed the Panel that as a consequence of Patient A’s problems, the Registrant needed to assess cognitive and physical abilities.

24. The Panel accepted the evidence of Witness JE. Although Patient A was known to have significant cognitive problems and difficulty with planning, organising and sequencing, the Panel noted that within the initial assessment completed by the Registrant on 29 January 2016, the section headed ‘Cognition’ had been left blank. The Panel also noted that there was no reference to Patient A’s physical abilities anywhere on the form. In these circumstances, the Panel concluded that there was no evidence that the Registrant had addressed the cognitive and physical abilities of Patient A during his assessment. The Panel was satisfied that Patient A’s cognitive and physical abilities had not been adequately assessed by the Registrant; if they had been, it is more likely than not that the Registrant’s findings would have been recorded.

25. Accordingly, particular 1(b) was found proved.

Particular 1(c) – Found Proved

‘Did not coordinate and/or provide Patient A with an intensive rehabilitation programme;’

26. Witness JE informed the Panel in her witness statement that the Team provides an intensive rehabilitation programme for patients, for up to 12 weeks. Witness JE stated that, during her supervision session, with the Registrant on 10 December 2015, she discussed Patient A’s need to have ‘lots of repetitive sessions as a result
 
of his cognitive issues’. The supervision note stated, ‘outdoor mobility joint with physio, wash and dress, meal preparation- needs lots of repetition - to coordinate with RA’s and see daily in the new year’. Witness JE stated that the Registrant was required to coordinate with the rehabilitation assistants to see Patient A every day for a two-week intensive period to assist him with getting into a structure and routine, after which the patient would be reviewed to assess whether improvements were being made.

27. The Panel accepted the evidence of Witness JE. The Panel was satisfied that it was the Registrant’s responsibility to ensure that Patient A was provided with intensive rehabilitation. The Panel noted that there was no evidence in the clinical records that the Registrant provided Patient A with a daily intensive rehabilitation programme, nor was there any evidence that he coordinated such a programme. In these circumstances, the Panel concluded that no intensive rehabilitation was provided or coordinated; if it had been, it is more likely than not that there would be evidence of it within the clinical records.

28. Accordingly, particular 1(c) was found proved.

Particular 1(d)(i) – Found Proved

‘Did not complete accurate and/or comprehensive progress notes in that you did not: provide clinical reasoning for doing paper-based activities with Patient A in notes dated 15 December 2015;’

29. Witness JE informed the Panel in her witness statement that when a patient is visited by a therapist a note should be recorded in relation to what happened during the visit and that these are referred to as progress notes. She stated that the information recorded should include the clinical reasoning for this intervention. She referred the Panel to the record of the Registrant’s visit to Patient A on 15 December 2015, which indicates that he showed the patient a series of photographs and asked him to spot the differences. Witness JE stated that there was no clinical reasoning for this paper-based activity and it was not clear what problem the activity was seeking to address.

30.  The Panel accepted the evidence of Witness JE. The Panel acknowledged that clinical reasoning is important for continuity of care. The Panel noted that the record
 
provided no explanation of the reason for the activity, what problem it would address and how the activity related to Patient A’s day to day life.

31. Accordingly, particular 1(d)(i) was found proved.

Particular 1(d)(ii) – Found Proved

‘‘Did not complete accurate and/or comprehensive progress notes in that you did not: complete and/or record an assessment of Patient A’s ability to make drinks and snacks in notes dated 15 January 2016;’
32. Witness JE stated in her witness statement that it is the occupational therapists’ role to carry out an assessment to see whether a patient has the ability to make drinks and snacks safely. She referred the Panel to the Registrant’s note of his visit with Patient A on 15 January 2016 which states, ‘[Patient A] said he was happy with his ability to make drinks, snacks’. Witness JE informed the Panel that whilst Patient A had daily carers to assist with these actions, the plan was for him to be supported so that he could complete them independently. She stated that the implementation of this plan required the Registrant to complete and record an assessment of his current abilities as a benchmark.

33. The Panel accepted the evidence of Witness JE. The Panel noted that although Patient A appeared to have confirmed that he was able to make drinks and snacks, there was no evidence in the clinical records that the Registrant conducted his own assessment of Patient A’s ability to carry out the tasks. The Panel was satisfied that the Registrant’s note indicated that he took Patient A’s word that he was able to undertake these tasks without completing an assessment. The Panel noted that this was a cause for concern because Patient A had cognitive difficulties and did not have full insight into his abilities.

34. Accordingly, particular 1(d)(ii) was found proved

 

 

Particular 1(d)(iii) – Found Proved

‘‘Did not complete accurate and/or comprehensive progress notes in that you did not:

record your clinical reasoning for conducting an assessment of patient A’s ability to process new information using a chess board in notes dated 16 December 2015;
 

35. Witness JE stated in her witness statement that when the Registrant visited Patient A on 16 December 2015, he spent the session assessing whether Patient A could process new information and learn a new skill by showing him chess pieces and explaining their movements on the board. He recorded that Patient A ‘could process new information and learn a new skill. He was shown a chessboard, the pieces and their movement explained. He said he found it very interesting and is keen to learn more about it next session’. Witness JE informed the Panel that it appeared that he was using the game of chess to address Patient A’s cognitive needs but was not relating the task to Patient A’s day to day activities.

36. The Panel accepted the evidence of Witness JE. The Panel noted that what Patient A required was assistance to make meals, get washed and dressed and learn a daily routine. However, there was no evidence of the clinical reasoning which justified carrying out the chess game activity with Patient A and how this related to the functional rehabilitation goals.

37. Accordingly, particular 1(d)(iii) was found proved

Particular 1(d)(iv) – Found Proved

‘Did not complete accurate and/or comprehensive progress notes in that you did not:

record the content of the tick sheet provided to Patient A on or around 22 January 2016;’

38. The Registrant recorded that he visited Patient A on 22 January 2016 and that during that visit the Registrant discussed a list of activities that the patient could carry out on a regular basis. He also indicated in the notes that he provided Patient A with a sheet to tick off the activities once they had been completed, which Witness JE informed the Panel was known as a ‘tick sheet’. Witness JE informed the Panel that patients often lose tick sheets and therefore it is good practice to keep a copy in the patients’ notes to provide evidence of the tasks that have been given. This also provides a ‘back-up’ if the patient loses it and provides access to this information for other members of the team. Witness JE stated during her oral
 
evidence that this was particularly important in relation to Patient A because of his known cognitive problems.

39. The Panel accepted the evidence of Witness JE. The Panel noted that there is no evidence in the progress notes about what the activities were or how often the patient had to complete them. There is also no further follow up about the tick sheet in the notes, nor is there a copy of the tick sheet itself.

40. Accordingly, particular 1(d)(iv) was found proved.

 

Particular 1(d)(v) – Found Proved

‘Did not complete accurate and/or comprehensive progress notes in that you did not:

record adequate information in notes completed on or around 25 January 2016 regarding patient A’s management of washing and/or dressing;

41. The Registrant visited Patient A on 25 January 2016 and within the notes recorded that Patient A stated that he did not want to shower even though it was ‘shower day’. Witness JE informed the Panel in her witness statement that there is no evidence within the note that the Registrant encouraged Patient A to have a wash as an alternative. She also stated that, whilst the note refers to Patient A changing out of his pyjamas into day wear, there was no detail relating to how he managed that task.

42. The Panel accepted the evidence of Witness JE. The Panel was satisfied that the Registrant should have, for example, specified whether Patient A could get dressed whilst sitting on the edge of the bed, whether he was able to change independently, whether he needed assistance, and if so the level of assistance required. In these circumstances, the Panel concluded that the Registrant’s note was not adequate.

43. Accordingly, particular 1(d)(v) was found proved.
 
Particular 1(d)(vi) – Found Proved

‘Did not complete accurate and/or comprehensive progress notes in that you did not:

record adequate information of Patient A’s abilities when taken to the shop in notes dated 12 February 2016;

44. The Registrant visited Patient A on 12 February 2016. The Registrant recorded that he took the patient for a walk to the local shops. Witness JE was not critical of the activity because one of Patient A’s goals was access to the community. However, she was critical of the absence of key information in the notes, such as road safety and money management. She stated in her witness statement that the Registrant’s note did not provide adequate detail, for example, whether Patient A could safely cross the road independently, whether he was able to manage his own money, whether he could access the shops by himself or whether he required further practice or supervision. Witness JE stated that these details are important as Patient A had both cognitive and physical difficulties.

45. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant’s note contained insufficient detail and was therefore an inadequate record.

46. Accordingly, particular 1(d)(vi) was found proved.

Particular 1(d)(vii) – Found Proved

 

‘Did not complete accurate and/or comprehensive progress notes in that you did not:

‘record adequate information about Patient A’s road safety and/or ability to manage money in notes dated 12 February 2016;

47. The Panel took into account its findings and reasoning in relation to particular 1(d)(vi). In addition, the Panel noted that Patient A was dependent on his friend to manage his finances and was therefore vulnerable. For the same reasons as stated above the Registrant’s note was not adequate.

48. Accordingly, particular 1(d)(vii) was found proved.
 
49. The Panel concluded that collectively its findings in relation to particulars 1(d)(i)- 1(d)(vii) demonstrate that the Registrant’s progress notes were neither accurate nor complete.

Particular 1(e)(i) – Found Proved

‘Did not complete in a timely manner:
a laundry assessment;’

50. Witness JE informed the Panel in her witness statement that during a laundry assessment an occupational therapist considers a patient’s management of laundry tasks by checking whether they can operate a washing machine, load and unload the washing machine, by taking the clothes out of the washing machine and putting them on an airer or tumble dryer etc. Although Patient A was receiving help from a friend with regard to his laundry, the therapy was aimed at building a routine structure for him so that he could gain more independence. The Patient’s laundry activity was observed by a RA on 1 February 2016. Witness JE informed the Panel that although it was legitimate for the washing, dressing and kitchen activities to take priority, the laundry assessment should not have been completed only two weeks before the patient was discharged. She stated that there was no reason for a delay of this length because Patient A could go to the kitchen independently and there was no reason why he could not physically do his laundry.

51. The Panel accepted the evidence of witness JE. The Panel noted that Patient A was allocated to the Registrant on 2 December 2015. The Panel concluded that the laundry assessment could have, and should have, been addressed earlier within Patient A’s rehabilitation programme, to enable the patient to get into a routine and be monitored by the occupational therapist. Therefore, the assessment which was conducted on 1 February 2016 was not timely.

52. Accordingly, particular 1(e)(i) was found proved.
 
Particular 1(e)(ii) – Found Proved

‘Did not complete in a timely manner:
an adequate lunch assessment.’

53. Witness JE informed the Panel that a lunch assessment involves an occupational therapist observing the patient making themselves something to eat. It includes an assessment of the patient’s ability to stand to carry out the task, any issues with regard to balance and whether the patient is able to use electrical equipment etc. The Registrant only observed Patient A making a cup of tea on 22 January 2016, and making breakfast on 25 January 2016. A lunch assessment was not completed by the Registrant for Patient A. On 2 February 2016, lunch practice was conducted by a RA.

54. The Panel accepted the evidence of Witness JE. She conceded during her oral evidence that the Registrant appeared to have graded Patient A’s activities on 22 and 25 January 2016. However, the Panel was satisfied that there was no evidence of any attempt to assist Patient A in undertaking more complex tasks such as planning, preparing and cooking a meal between December 2015, when the case was allocated and 2 February 2016 when the lunch practice with a RA was completed. Therefore, the Panel concluded that the Registrant’s lunch assessment was not adequate and was not timely.

55. Accordingly, particular 1(e)(ii) was found proved.

Patient B

56. Patient B was allocated to the Registrant from 8 January 2016 to 23 February 2016. Patient B had suffered a stroke in October 2015, and experienced left sided weakness as a result. He had left upper limb problems and reduced function in his left arm.
 
Particular 2(a) – Found Proved

‘Did not complete an upper limb assessment in a timely manner or at all;

57. Witness JE informed the Panel in her witness statement that although the Registrant completed a treatment plan, in which he referred to Patient B having no functional movement in his left upper limb, there was no actual record of the upper limb assessment within the records.

58. The Panel accepted the evidence of Witness JE that an initial assessment should have been conducted to identify the issues which would form the basis of a treatment plan. There was no evidence of an upper limb assessment in the notes. In these circumstances, the Panel concluded that no assessment had taken place; if it had been, it is more likely than not that there would be evidence of it within the clinical records.

59. Accordingly, particular 2(a) was found proved.

Particular 2(b) – Found Not Proved

‘No evidence offered’

60. The HCPC offered no evidence in relation to particular 2(b). The Panel was unable to identify any evidence in support of the allegation in the witness statement of Witness JE or in the exhibits.

61. Accordingly, particular 2(b) was found not proved.

Particular 2(c)(i) and 2(c)(ii) – Found Proved
‘Did not record progress notes in a timely manner in relation to home visits completed on or around:
13 January 2016;

15 January 2016.’

62. Witness JE referred the Panel to the Trust’s Clinical Record Keeping Policy which

22
 
has occurred providing current information on the care and condition of the patient (and within a maximum of 24 hours of the contact).’

63. The Panel accepted the evidence of Witness JE and noted that the Registrant’s visit with Patient B on 13 January 2016, and 15 January 2016 were not recorded in the notes until 21 January 2016. The Panel was satisfied that the 5-day and 3- day delay (excluding weekends) in recording the visits was not timely given the Trust’s policy and the potential impact on the care of the patient by other professionals in the intervening period.

64. Accordingly, particulars 2(c)(i) and 2(c)(ii) were found proved.

Particular 2(d) – Found Proved
‘Did not complete and/or record a cutlery assessment for Patient B;’

65. Witness JE informed the Panel in her witness statement that when a patient experiences difficulty in feeding themselves, the occupational therapist should carry out a feeding assessment which involves observing the patient and giving consideration to adapted cutlery to facilitate the patient’s independence when eating. She referred the Panel to the Registrant’s initial assessment of the patient on 12 January 2016, where he had recorded that Patient B ‘needs someone to cut up some foods.’ She stated that there was no subsequent cutlery assessment to help facilitate the patient’s independence.

66. The Panel accepted the evidence of Witness JE. The Panel was satisfied that a cutlery assessment should have been completed by the Registrant and there was no evidence that it was done. In these circumstances the Panel concluded that no assessment had taken place; if it had been, it is more likely than not that there would be evidence of it within the clinical records.

67. Accordingly, particular 2(d) was found proved.

Particular 2(e)(i) – Found Proved

‘On or around 01 February 2016, you:
took Patient B upstairs without input from a Physiotherapist;’
 

68. The Registrant recorded a visit with Patient B on 1 February 2016. Witness JE stated that at that time Patient B was living on the first floor of his partner’s property and was still in the process of practising using the stairs at that address. As of 27 January 2016, the Registrant was not deemed safe to use the stairs independently and the stair practice had been handed over to Patient B’s partner. Prior to Patient B’s stoke he had been living at his parents’ property. On 1 February 2016, the Registrant accompanied Patient B to his parents’ house and at that address took him upstairs. Witness JE informed the Panel that Patient B had only been observed by a physiotherapist on the stairs of his partner’s property. She stated that it was evident from previous physiotherapy input as documented in the clinical notes that Patient B required ‘a lot of preparation and handling to facilitate normal movement, which is outside the scope of OT practise.’

69. The Panel noted that the Registrant referred to taking the patient backwards down the stairs at his parents’ address. There is no mention of any other person assisting with this task. The Panel accepted the evidence of Witness JE that where a patient is struggling with steps and stairs, it is the physiotherapists’ role to assess this, because it is a mobility issue. There was no evidence before the Panel that there was any input from a physiotherapist at Patient B’s parents’ address.

70. Accordingly, particular 2(e)(i) was found proved.

Particular 2(e)(ii) – Found Proved

‘On or around 01 February 2016, you:
did not conduct a risk assessment and/or identified risks but completed the assessment with Patient B in any event;’

71. Witness JE informed the Panel in her witness statement that a risk assessment is carried out every time that an intervention is considered. She stated that the Registrant should have completed a risk assessment before undertaking the intervention with Patient B on 1 February 2016.

72. The Panel accepted the evidence of Witness JE. The Panel noted that Patient B was in an environment in which he had not been previously assessed and where
 
the Registrant completed several different tasks. The Panel also noted that the Registrant had identified that there was no supporting rail when going downwards, and the stairs were steeper and had less tread. The Panel concluded that the intervention should not have been undertaken in the absence of a risk assessment due to the risk of harm to Patient B and the Registrant. The Panel took to view that the patient was at risk of falls on stairs and by conducting the activity alone as he did he placed the patient and himself at risk. The Panel was satisfied that no assessment had taken place; if it had, it is more likely than not that there would be evidence of it within the clinical records.

73. Accordingly, particular 2(e)(ii) was found proved.

Particular 2(f) – Found Proved

‘Did not arrange and/or provide Patient B with sufficient upper limb rehabilitation;

74. Witness JE informed the Panel in her witness statement that Patient B’s key issue was the function of his left upper limb. She stated that the Registrant talked about seeing Patient B on a regular basis during supervision, but this was not reflected in the notes. Witness JE informed the Panel that in two months, the notes indicate that the Registrant has conducted approximately seven upper limb rehabilitation sessions with Patient B, which she stated was insufficient given his clinical presentation. Witness JE suggested that the Registrant should have been seeing Patient B twice a week from 12 January to 23 February 2016. Therefore, he should have had approximately 13 appointments with Patient B aimed at improving Patient B’s upper limb function.

75. The Panel accepted the evidence of Witness JE. The Panel was satisfied that it was the Registrant’s responsibility to arrange or provide Patient B with sufficient upper limb rehabilitation. The Panel concluded that seven sessions was insufficient and that if there had been more, it is more likely than not that there would be evidence of it within the clinical records.

76. Accordingly, particular 2(f) was found proved.
 
Particular 2(g)(i) – Found Proved

‘On or around 22 February 2016, you took Patient B for a walk outdoors during his therapy session;
which was outside your scope of practice’

77. On 22 February 2016, the Registrant went for a walk with Patient B. Witness JE informed the Panel in her witness statement that this was outside the scope of occupational therapy as it did not include a task that the Registrant would observe, such as walking to the shops and paying a bill. She stated that, as occupational therapists are not trained in assessing and advising on gait patterns and walking aids, an intervention purely related to practising mobility should have been undertaken by a physiotherapist.

78. The Panel accepted the evidence of Witness JE. The Panel was satisfied that the Registrant’s walk with Patient B was outside his scope of practice.

79. Accordingly, particular 2(g)(i) was found proved.

Particular 2(g)(ii) – Found Proved

‘On or around 22 February 2016, you took Patient B for a walk outdoors during his therapy session;
without a clinical reason for doing so;’

80. Witness JE informed the Panel in her witness statement that when she asked the Registrant about the walk that had taken place on 22 February 2016, he stated that he had taken Patient B out ‘because it was nice weather.’ She stated that the Registrant did not provide any clinical reasoning.

81. The Panel accepted the evidence of Witness JE. The Panel noted that there was no clinical reasoning in the clinical records and none was provided verbally to Witness JE. Therefore, the Panel concluded that the intervention was undertaken without clinical reasoning.

82. Accordingly, particular 2(g)(ii) was found proved.
 
Particular 2(h) – Found Not Proved

‘Acted outside your scope of practice in that the treatment plan dated 21 January 2016 included facilitating Patient B’s appeal against his Personal Independence Payment (PIP) decision and/or you did not refer Patient B to Patient Information Services to deal with his PIP’

83. On 21 January 2016, the Registrant completed a treatment plan. Within the ‘Problems’ section the Registrant had written, ‘Facilitate appeal against PIP decision to give him only standard rate for mobility component’. The Panel was informed that a Personal Independence Payment is awarded to an individual by the government following an assessment to assist them with some of the extra costs caused by long term ill-health or disability. Witness JE stated in her witness statement that dealing with this issue is not within the Registrant’s scope of practice as an occupational therapist. She stated that the appropriate course of action would have been to refer the matter to Patient Information Services who could support the patient through the appeal process. However, during her oral evidence, Witness JE conceded that, based solely on the entry in the records, the Registrant could simply have been offering to signpost Patient B to others for support. She stated that it would be appropriate for an occupational therapist to pass on this issue to others. She also stated that her view of the Registrant’s intended involvement was partly based on a discussion that she had with him.

84. The Panel accepted the evidence of Witness JE. However, the Panel concluded that the criticism of the Registrant as set out in the Allegation was based on the record he made in the treatment plan. The Panel noted that the reference to a conversation with the Registrant only came to light during the Panel’s questions and there was no mention of it in the supervision notes. As Witness JE accepted that it was possible that the entry was no more than an offer to refer the patient to a service that could assist him, the Panel concluded that the HCPC had not discharged the burden of proof.

85. Accordingly, particular 2(h) was found not proved.
 
Patient C

86. Patient C was allocated to the Registrant on 15 December 2015 and had his first session with him on 30 December 2015. Patient C’s last session was with the Registrant on 24 February 2016. Patient C had suffered a stroke and he was very physically impaired. He lived with his wife and had assistance from two carers, four times a day.

Particular 3(a) – Found Proved

‘Between 15 December 2015 and 24 February 2016, in relation to Patient C you:
Did not conduct and/or record an initial assessment for Patient C, in a timely manner;

87. Witness JE informed the Panel in her witness statement that according to the clinical records the Registrant’s initial appointment with Patient took place on 30 December 2015. She stated that during this appointment the Registrant should have completed an initial assessment to establish a baseline of information in relation to Patient C. However, the Registrant did not conduct and record the initial assessment until 10 February 2016, which is the same date as the treatment plan. Witness JE informed the Panel that such a delay in completing the initial assessment causes a delay to the commencement of a patient’s potential progress from an occupational therapy perspective.

88. The Panel accepted the evidence of Witness JE. The Panel was satisfied that there was an unjustified delay in completing the initial assessment and therefore the assessment which was conducted on 10 February 2016, was not timely.

89. Accordingly, particular 3(a) was found proved.

Particular 3(b) – Found Proved

‘Did not carry out a Wash & Dress assessment for Patient C in a timely manner;’

90. Witness JE informed the Panel in her witness statement that wash and dress assessments involve considering the patient’s ability to dress, undress and wash themselves. She stated that for Patient C, washing and dressing was a main goal from an occupational therapy perspective. She informed the Panel that a second person was required to assist with the assessment due to Patient C’s manual
 
handling needs and that this should have been organised within one or two weeks of the referral. The first time that the Registrant did a therapeutic wash and dress assessment with Patient C was on 24 February 2016.

91. The Panel accepted the evidence of Witness JE. The Panel noted that on 13 January 2016, and again on 18 January 2016, Witness JE reminded the Registrant that the wash and dress assessment had to be conducted as a matter of priority. However, the assessment was not undertaken until 24 February 2016. The Panel concluded that there was an unjustified delay in conducting the assessment and therefore was not timely.

92. Accordingly, particular 3(b) was found proved.

Particular 3(c) – Found Proved

‘Did not conduct a splint session and/or identify the need for a splint for Patient C’s upper limb in a timely manner;

93. Witness JE informed the Panel that the physiotherapist identified issues with Patient C’s wrists and hands on 24 December 2015. She informed the Panel that throughout January 2016 the Registrant was undertaking left arm and hand exercises, whilst the physiotherapists were positioning and stretching his hands and wrists. This was discussed with the Registrant during supervision on 13 January 2016, but it was not until 4 February 2016, that the Registrant performed a joint splint session with a colleague. She stated that a patient may not require a splint initially but the need for a splint could develop later. Witness JE informed the Panel that the need for a splint should have been considered during the initial assessment but the initial assessment was not conducted until 10 February 2016. She stated that if the Registrant had completed the initial assessment thoroughly at the start, the splint issue should have been identified. There was no evidence in the notes that the Registrant conducted an upper limb assessment in order to observe and identify the issues with the Patient’s hand and wrist, which would have been part of his role as an occupational therapist.
 
94. The Panel accepted the evidence of Witness JE. The Panel concluded that although the Registrant conducted the joint splint session on 4 February 2016 it was not timely as there was an unjustified delay.

95. Accordingly, particular 3(c) was found proved.

Particular 3(d) – Found Proved

‘Did not arrange and/or provide Patient C with upper limb rehabilitation in a timely manner;’

96. Witness JE informed the Panel in her witness statement that the Registrant being aware of the Patient C’s upper limb problems, he did not carry out any upper limb rehabilitation until 27 January 2016, approximately one month after the initial appointment. The rehabilitation that he did provide consisted of ‘some stretches and bilateral stretches.’

97. The Panel accepted the evidence of Witness JE. The Panel concluded that there was an unjustified delay in providing Patient C with upper limb rehabilitation and accordingly found this to be untimely.

98. Accordingly, particular 3(d) was found proved.

Particular 3(e) – Found Proved

‘Did not conduct and/or record a discussion with Patient C’s care provider and/or social workers regarding the concerns raised by Patient C on or around 30 December 2015 and/or 19 January 2016;

99. On 30 December 2015, Patient C raised a concern that, although he was continent, his carers made him use a pad in order to avoid having to hoist him on to a commode. The same concern was raised by the patient on 19 January 2016. Witness JE informed the Panel that the Registrant told Patient C that he would speak to Patient C’s social worker and the carers company. She stated that this was appropriate but there was no evidence that he followed this up.
 
100. The Panel accepted the evidence of Witness JE. The Panel accepted that the concerns should have been raised with Patient C’s care provider and his social worker. However, there was no evidence that he did so. The Panel also concluded that this failure to act posed risks to tissue viability and the dignity and wellbeing of Patient C.

101. Accordingly, particular 3(e) was found proved.

 

Particular 3(f) – Found Proved

‘Did not conduct sessions and/or record reasons why Patient C missed rehabilitation sessions on dates between 07 January 2016 and 19 January 2016.

102. According to the records the Registrant did not see Patient C at all during the week commencing 7 January 2016, or the week commencing 19 January 2016. Witness JE informed the Panel that the Registrant should have seen Patient C at least twice a week or should have arranged for a rehabilitation assistant to see the patient. She stated that it was unclear why no visits took place during that period as he was not on annual leave, Patient C was not too unwell to undergo therapy and there was no note to indicate that Patient C had cancelled his appointments. The Panel also observed that a number of other appointments with team practitioners had taken place during this time period.

103. The Panel accepted the evidence of Witness JE. The Panel was satisfied that no rehabilitation sessions took place with Patient C during the relevant period and no reason for this was discernible form the clinical records.

104. Accordingly, particular 3(f) was found proved.

Particular 3(g)(i) – Found Proved

‘Did not record comprehensive progress notes including:

Details of upper limb rehabilitation carried out with Patient C on or around 27 January 2016;
 
105. The Panel noted that the Registrant’s record of his visit with Patient C on 27 January 2016 simply stated, ‘carried out some stretches and bilateral stretches’, despite Patient C having no functional use in his hand.

106. The Panel concluded that the Registrant’s note provides no detail of whether the stretches were to the Patient’s shoulder elbow, thumb, wrist, or fingers. Therefore, the record was not comprehensive.

107. Accordingly, particular 3(g)(i) was found proved.

Particular 3(g)(ii) – Found Not Proved

‘Did not record comprehensive progress notes including:
‘A record of your discussion with Patient C about indoor gardening;

108. Witness JE informed the Panel in her witness statement that the issue with regard to the indoor gardening activity was its relevance to Patient C after the therapy came to an end. She stated that the Registrant did an initial indoor gardening session with Patient C on 17 February 2016, but did nothing further to follow this up.

109. The Panel accepted the evidence of Witness JE. However, the Panel concluded that the criticism of the Registrant was based on the nature and content of his record of his discussion with Patient C. The Panel concluded that the record of the discussion was sufficiently comprehensive.

110. Accordingly, particular 3(g)(ii) was found not proved.

 

Particular 3(h) – Found Not Proved

‘On or around 09 February 2016, you acted outside scope of practice by discussing communication, and practising phrases and words with Patient C.
111. The Registrant visited Patient C on 9 February 2016, and documented that, ‘OT recorded [Patient C] saying some well know[n] phrases and he was able to produce words with more clarity and volume than usual.’ Witness JE informed the Panel in her witness statement that it is the role of a Speech and Language
 
therapist to treat a patient’s speech. The treatment of speech lies outside the scope of an occupational therapist’s role.

112. The Panel accepted the evidence of Witness JE. However, the Panel noted that Registrant’s entry in Patient C’s records went on to state, ‘He consented to my sharing the recordings with his SLT [speech and language therapist]’. The Panel took the view that this indicated that the Registrant was not attempting to treat or assess Patient C’s speech, which was outside his scope of practice, but was obtaining information to pass on to a speech and language therapist within the Team, which was within his scope of practice.

113. Accordingly, particular 3(h) was found not proved.

 

Particular 3(i) – Found Proved

‘On or around 10 February 2016, the intervention you provided for Patient C was inappropriate in that it provided them with too much postural support.

114. On 7 January 2016, the Registrant identified that there were issues with Patient C’s positioning in his armchair and on 10 February 2016, conducted a wash and dress assessment. Witness JE informed the Panel in her witness statement that having noted the re-positioning issue, the Registrant’s intervention was to order a tilt-in-space armchair for the patient. She stated that there was no evidence he discussed the issues with the treating physiotherapist. She also stated that this type of equipment would provide too much postural support and therefore would interfere with the rehabilitation goal to improve Patient C’s trunk control whilst seated.

115. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant’s intervention was inappropriate. Whilst it provided an immediate solution to the patient’s postural support needs, it failed to take into account the potential to improve trunk stability for Patient C.

116. Accordingly, particular 3(i) was found proved.

33
 
Patient D

117. Patient D was allocated to the Registrant between 13 May 2016, and 27 June 2016. Patient D had experienced a stroke and was wheelchair dependent. He had to be hoisted for transfers and he had no activity in his left arm. His predominant goals included washing, dressing, cooking, moving his left arm and toileting.

Particular 4(a) – Found Proved

‘Between 13 May 2016 and 30 June 2016, in relation to Patient D you: Did not complete a treatment plan for Patient D in a timely manner;

118. The Registrant documented that he conducted an initial assessment of Patient D on 16 May 2016. However, the treatment plan was not completed until 3 June 2016. Witness JE informed the Panel in her witness statement that the treatment plan should have been completed at the same time as the initial assessment or in the following session.

119. The Panel accepted the evidence of Witness JE. The Panel was satisfied that there was no evidence that the two-week delay was justified. Therefore, the Panel determined that the completion of the treatment plan was not timely.

120. Accordingly, particular 4(a) was found proved.

 

Particular 4(b) – Found Proved

‘Did not complete and/or record an adequate upper limb assessment for Patient D, in a timely manner, or at all’

121. Witness JE informed the Panel that the upper limb assessment for Patient D should have been completed within the first two or three sessions as he had no function in his left arm. She stated that the upper limb assessment was required to assess his arm from the shoulder down to his hand. Witness JE informed the Panel that although the Registrant had written some information in the clinical
 
notes on 18 May 2016, and 1 June 2016, the records are not adequate as they include only vague comments about Patient D’s hand movements.

122. The Panel accepted the evidence of Witness JE. A full upper limb assessment for Patient D was not completed until the 17 June 2016, by another practitioner. The Panel concluded that an upper limb assessment had not been completed in a timely manner. Although the Panel accepted that the Registrant had completed an upper limb assessment for Patient D it determined that his assessment was not adequate as there were several findings missing, for example, any sensation problems, pain or swelling. The Panel took the view that if an adequate assessment had been conducted, it was more likely than not that such significant findings would have been recorded in the notes.

123. Accordingly, particular 4(b) was found proved.

 

Particular 4(c)– Found Proved

Did not complete and/or record a risk assessment for taking Patient D outside in a wheelchair on or around 23 May 2016 and/or 03 June 2016.

124. Patient D was wheelchair dependent and there was a step into his property with no immediate ramped access. Witness JE informed the Panel in her witness statement that the transport team had carried out its own risk assessment and determined that Patient D required the assistance of two people when being moved, even with ramps in situ. The Registrant took Patient D outside on 23 May 2016, and 3 June 2016, during his visits to the patient. Witness JE informed the Panel that the Registrant should have conducted a risk assessment before doing so. There was no evidence that the Registrant had the assistance of another person.

125. The Panel accepted the evidence of Witness JE. The Panel noted that although the Registrant pulled the patient down the ramp backwards there was a risk that injury could have been caused to one or both of them. There was no evidence in the records, on either date, that the Registrant assessed the risks associated with taking Patient D outside. The Panel concluded that no risk assessment had
 
been undertaken; if it had been, it was more likely than not that there would have been a note of it in the clinical records.

126. Accordingly, particular 4(c) was found proved.

Particular 4(d)(i)– Found Proved

‘Did not complete comprehensive and/or timely notes including: notes of an initial assessment completed on or around 16 May 2016;
127. The Registrant commenced Patient D’s initial assessment on 16 May 2016. Witness JE referred to it in her witness statement as being only partially completed as it was unclear what level of function Patient D had, given that the majority of the sections relating to ‘current level of function’ had been left blank.

128. The Panel accepted the evidence of Witness JE. The Panel noted that the missing sections included key activities such as feeding, toileting, kitchen, housework, laundry and access to the community etc. The Panel concluded that, in the absence to references to these matters, the initial assessment was not comprehensive.

129. Accordingly, particular 4(d)(i) was found proved.

Particular 4(d)(ii)– Found Proved

Did not complete comprehensive and/or timely notes including: A record of a visit carried out on or around 14 June 2016;
130. Witness JE’s supervision notes confirm that she had a discussion with the Registrant with regard to ‘walking’ with Patient D. Witness JE was concerned by the Registrant’s actions because he had been told by a Band 7 physiotherapist that Patient D should only walk during physiotherapy sessions. The visit took place on or around 14 June 2016, but there is no note of this visit in the clinical records.

131. The Panel accepted the evidence of Witness JE. It is clear that the visit took place on or around 14 June 2016, as it is referred to by Witness JE in a supervision
 
note dated 14 June 2016. The Panel concluded that as the visit was not recorded the notes were not comprehensive and was not timely as it was never recorded.

132. Accordingly, particular 4(d)(ii) was found proved.

 

Particular 4(d)(iii)– Found Not Proved

‘Did not complete comprehensive and/or timely notes including: Notes of a visit carried out on or around 17 June 2016;’
133. On 20 June 2016, the Registrant recorded that he visited Patient D on 17 June 2016. Witness JE referred the Panel to the Trust’s Clinical Record Keeping Policy which requires clinical visits to be recorded within 24 hours. The Registrant’s session notes indicate that the entry was made late because the notes were unavailable on 17 June 2016.

134. The Panel noted that 17 June 2016, was a Friday and that 20 June 2016, was a Monday. The Panel was satisfied that a reasonable reading of the Trust’s policy was that it excludes weekends from the maximum 24-hour time frame. The Panel concluded that the Registrant’s entry in the patient notes recorded at 9.30 am on Monday 20 June 2016, was within the maximum time period. Therefore, the recording of this note could not properly be described as untimely.

135. Accordingly, particular 4(d)(iii) was found not proved.

 

Particular 4(d)(iv)– Found Proved

‘Sufficient clinical reasoning for using Chessington Occupational Therapy Neurological Assessment Battery (COTNAB) on or around 17 June 2016 and/or 27 June 2016;’

136. Witness JE informed the Panel that the Registrant did not identify any cognitive problems in his initial assessment, which took place on 17 June 2016, and therefore his use of COTNAB was not appropriate or relevant to Patient D’s needs. She also stated that there was no clinical justification for the Registrant’s use of
 
another part of COTNAB on 27 June 2016, which was used without providing a rationale.

137. The Panel accepted the evidence of Witness JE. The Panel notes that COTNAB is for the assessment of patients with brain injury and strokes and contains a variety of tests for the assessment of functional and perceptual dysfunction with neurological patients aged 16 upwards. Although the Panel noted that Patient D had suffered a stroke, the initial assessment had not identified any cognitive problems in relation to Patient D and therefore there was no clinical reasoning for the use of COTNAB during the visits which took place on 17 June 2016 and 27 June 2016.

138. Accordingly, particular 4(d)(iv) was found proved.

 

Particular 4(e) – Found Proved

‘You acted outside your scope of practice and/or conducted an exercise you had been advised not to in that on or around 14 June 2016, you walked Patient D during his therapy session;’

139. Witness JE informed the Panel in her witness statement that Patient D required specialist therapeutic handling by a physiotherapist to ensure that he moved in the most normal pattern. She stated that gait analysis is outside the scope of occupational therapy.

140. The Panel accepted the evidence of Witness JE. The Panel took into account its findings in relation to particular 4(d)(ii) and concluded that walking Patient D was outside the Registrant’s scope of practice.

141. Accordingly, particular 4(e) was found proved.

Particular 4(f) – Found Not Proved

‘In or around July 2016, you visited Patient D at his home when there was no clinical reason to do so;’
 
142. Witness JE informed the Panel in her witness statement that approximately two weeks after the Registrant resigned from the Trust, he visited Patient D at his home address. She stated that the Trust only became aware of the visit because the patient was still under the Trust’s care and mentioned it to another occupational therapist. Witness JE informed the Panel that there was no clinical justification for the visit as the Registrant was no longer employed by the Trust.

143. The Panel noted that on 12 August 2016, an occupational therapist visited Patient D. The occupational therapist subsequently recorded in the clinical notes that Patient D confirmed that the Registrant had visited him the previous day. The previous day would have been 11 August 2016. The Panel concluded that the natural reading of ‘in or around July 2016’ did not include a date in August 2016. The Panel considered whether to amend particular 4(f), of its own volition, but decided that that would not be in the interests of justice as it was clearly possible for the HCPC to have identified the correct date from the documentation in advance of the hearing.

144. Accordingly, particular 4(f) was found not proved.

Patient E

145. Patient E was allocated to the Registrant between 15 February 2016 and 23 February 2016. Patient E had a brain tumour and had undergone surgery to remove the tumour. The operation had left him with some mild mobility problems. Patient E had slight hand problems, issues with his memory, and fatigue. Patient E also had some issues with anger and frustration, and he could become angry quite quickly.

Particular 5(a) – Found Proved

‘Between 15 February 2016 and 23 February 2016, in relation to Patient E you: Did not complete and/or record a treatment plan;
146. The Registrant completed an initial assessment of Patient E on 16 February 2016. However, there was no evidence of a treatment plan. Witness JE informed the Panel in her witness statement that there should have been a treatment plan as it forms part of the standard occupational therapy documentation.
 
147. The Panel accepted the evidence of Witness JE. The Panel noted that without the treatment plan there was no evidence that the Registrant had identified the patient’s problems and/or how to treat them. The Panel concluded that no treatment plan had been completed; if it had been, it was more likely than not that a copy of it would be in the patient records.

148. Accordingly, particular 5(a) was found proved.

 

Particular 5(b) – Found Proved

‘Did not complete an adequate initial assessment on or around 16 February 2016, in that you:

Did not adequately assess/or record an adequate assessment of Patient E’s level of cognition’

149. Witness JE informed the Panel in her witness statement that the purpose of the initial assessment is to obtain key information about the patients’ current level of disability compared to their abilities prior to the injury. She stated that although the Registrant completed the general information and completed the sections relating to what Patient E could do before his injury, there was no information about the patient’s current level of cognitive function.

150. The Panel accepted Witness JE’s evidence. The Panel noted that there was no reference in the documentation to Patient E’s level of cognition which was particularly important given that he was a patient with a neurological condition. There was also no evidence that the Registrant had considered Patient E’s overall needs other than his anger and bathing issues. In these circumstances, the Panel concluded that the Registrant’s initial assessment was not adequate.

151. Accordingly, particular 5(b) was found proved.
 
Particular 5(c)(i) – Found Proved

‘Acted outside your scope of practice in that:

On or around 22 February 2016, you made inappropriate recommendations to Patient E’s family regarding his temper;’

152. Patient E had anger management issues. The Registrant visited Patient E on or around 22 February 2016, and made the following entry in his clinical records: ‘Discussed ways of helping him manage his temper, they agreed that filming him on their smartphone and showing it to him when he was in a good mood would be helpful’. Witness JE informed the Panel in her witness statement that the Registrant’s recommendation was inappropriate because occupational therapists do not receive specialist training in the management of behavioural issues. Moreover, she was not aware that the Registrant had undertaken any specialist additional training. She stated that Patient E’s behavioural problems fell within the scope of practice of a clinical psychologist.

153. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant’s intervention was inappropriate because it had the potential to aggravate Patient E and make the situation worse.

154. Accordingly, particular 5(c)(i) was found proved.

 

Particular 5(c)(ii) – Found Not Proved

‘Acted outside your scope of practice in that:

On or around 23 February 2016, you documented a plan to discuss Patient E’s emotions.’

155. The Registrant documented in Patient E’s clinical records on or around 23 February 2016 that, ‘next session teach calming exercises & discuss’. Witness JE informed the Panel in her witness statement that it was not inappropriate for an occupational therapist to recommend relaxation and calming exercises for anxious patients. However, she stated that Patient E had more challenging behavioural problems relating to anger management rather than anxiety management. Witness JE informed the Panel that although an occupational therapist would consider the
 
patient’s issues holistically, the management of emotions fell within the specialist scope of practice of a psychologist.

156. The Panel accepted the evidence of Witness JE. The Panel noted that the criticism in the allegation was that the Registrant’s plan for the next session was outside his scope of practice. However, the Panel took the view that the record simply indicated a willingness to teach calming exercises and to discuss the issue which may have led to a referral to a psychologist. The Panel was not satisfied that the note indicated that the Registrant was acting outside of his scope of practice given his responsibility to consider Patient E’s problems holistically and Witness JE’s acknowledgement that it was appropriate for an occupational therapist to engage in a general conversation about emotional issues.

157. Accordingly, particular 5(c)(ii) was found not proved.

 

Patient F

The Registrant was allocated Patient F between 29 March 2016 and 30 June 2016. Patient F had suffered a stroke and he was wheelchair dependent. He was able to sit and balance independently, as well as transfer with the assistance of one other person. He had no use of his left upper limb.

Particular 6(a) – Found Proved

‘Between 29 March 2016 and 30 June 2016, in relation to Patient F you:

Did not complete and/or record an adequate initial assessment of Patient F, in a timely manner;

158. The Registrant had his first appointment with Patient F on 5 April 2016. Witness JE informed the Panel in her witness statement that the initial assessment should have taken place during the first appointment but was not completed until 11 May 2016, approximately four weeks after the first appointment. She stated that the initial assessment did not correspond with the clinical notes as the dates were unclear and she also stated that the initial assessment was incomplete as the section on current level of function was left blank.

159. The Panel accepted the evidence of Witness JE. The Panel noted that the Registrant’s initial assessment made no reference to the level of function of Patient
 
F and little evaluation of cognition. The Panel concluded that for these reasons the initial assessment was not adequate. During the supervision session with the Registrant on 21 April 2016, Witness JE expressed some concern that there was no initial assessment or treatment plan in the notes. The Panel also noted that there was a partially completed initial assessment dated 20 April 2016. However, the Panel took the view that even if the initial assessment had been completed by 20 April 2016, it would still not have been timely given that the Registrant’s first appointment with the Registrant was on 5 April 2016.

160. Accordingly, particular 6(a) was found proved.

 

Particular 6(b) – Found Proved

‘Did not complete an accurate treatment plan in a timely manner;’

161. Witness JE informed the Panel in her witness statement that the absence of a treatment plan was raised the Registrant during a supervision session which took place on 21 April 2016. She stated that there was still no treatment plan in Patient F’s notes as of 21 April 2016. Witness JE informed the Panel that there was nothing in the treatment plan outlining the reason for the treatment.

162. The Panel accepted the evidence of Witness JE. The Panel noted that the treatment plan was outstanding several weeks after the initial appointment with Patient F and after treatment had already commenced. In these circumstances the Panel conclude that it was not an accurate treatment plan and was not completed in a timely manner.

163. Accordingly, particular 6(b) was found proved.

Particular 6(c) – Found Not Proved

‘Did not complete and/or record progress notes of a splinting session with Patient F on or around 16 June 2016;

164. Witness JE informed the Panel in her witness statement that the Registrant and a Band 7 occupational therapist carried out a splinting session on 16 June 2016. The Registrant did not record any notes for the session. They were written up retrospectively by the Band 7 occupational therapist on 22 June 2016, but it had
 
apparently been agreed that the Registrant would write up the notes. Witness JE stated that as Patient F was the Registrant’s patient, it was his responsibility to complete the notes.

165. The Panel noted that the ‘agreement’ between the Band 7 occupational therapist and the Registrant that he should write up the notes was hearsay and was not supported by a contemporaneous note. In addition, the Panel was not persuaded the HCPC had adduced sufficient evidence that during a joint therapy session, involving therapists with different levels of seniority, it was the responsibility of the Registrant to complete and record the notes. Therefore, the Panel was not satisfied that it was the Registrant’s responsibility to complete or record the notes of the splinting session.

166. Accordingly, particular 6(c) was found not proved.

Particular 6(d) – Found Proved

‘Did not complete and/or record a kitchen assessment in a timely manner;

167. Witness JE informed the Panel in her witness statement that one of Patient F’s goals was to complete basic kitchen activities. She stated that a kitchen assessment involves observing the patient making a cold and hot drink and possibly progressing to making breakfast. During a supervision session with the Registrant on 11 April 2016, she advised the Registrant to invite Patient F to attend the hospital to start practicing kitchen skills. She stated that on 12 May 2016, the Registrant identified that Patient F had difficulty with kitchen activities. On 17 May 2016, the Registrant had a discussion with Patient F during a visit with regard to a kitchen assessment and on 6 June 2016, the Registrant made reference to a burn on Patient F’s left hand which had healed. Witness JE stated that as of 24 June 2016, there was no evidence that the kitchen assessment had been completed.

168. The Panel accepted the evidence of Witness JE. The Panel noted that the need for a kitchen assessment had been identified in early May and concluded that it should have been completed within a reasonable time period. The Panel was satisfied that an unexplained delay of four to five weeks was unreasonable and was not timely.

169. Accordingly, particular 6(d) was found proved.
 
Particular 6(e) – Found Not Proved

‘Did not provide and/or record providing advice to Patient F regarding his splint;

170. Witness JE informed the Panel in her witness statement that the Registrant did not give Patient F any guidance in relation to how to put his splint on, or how long to wear it for. She stated that there was no reference to any guidance in the clinical notes and no instructions were in the file.

171. The Panel took into account its findings in relation to particular 6(a). The Panel was not satisfied that the HCPC had adduced sufficient evidence that during a joint therapy session, involving therapists with different levels of seniority, it was the responsibility of the less senior occupational therapist (the Registrant) to provide the patient with advice with regard to the use of the splint.

172. Accordingly, particular 6(e) was found not proved.

 

Particular 6(f) – Found Not Proved

‘In or around the week commencing 23 May 2016, you failed to appreciate the risk of conducting a joint splinting session with Patient F despite him having a burn on his hand.

173. In the week commencing 23 May 2016, the Registrant had arranged a joint session with the Band 7 occupational therapist. Witness JE informed the Panel in her witness statement that the Registrant was informed by the Band 7 occupational therapist that the session should be cancelled because Patient F had a burn on his hand and a splint would put pressure on the affected area. A record of this account was contained in Witness JE’s supervision notes.

174. The Panel accepted that Witness JE relayed the information as she understood it be. However, the Panel noted that the conversation that was said to have taken place between the Band 7 occupational therapist and the Registrant was hearsay and, in these circumstances, afforded it little weight. There was no statement from the Band 7 occupational therapist and no contemporaneous note of the discussion.
 
In these circumstances, the Panel concluded that insufficient evidence had been adduced by the HCPC.

175. Accordingly, particular 6(f) was found not proved.

Particulars 6(g)(i) and 6(g)(ii) – Found Not Proved

‘Did not adequately address the patient’s washing and dressing needs in that: you only conducted one washing and dressing assessment;’
you only practised washing and dressing with the patient once in six weeks;’

176. Witness JE informed the Panel in her witness statement that the Registrant did not adequately address Patient F’s washing and dressing needs in a timely manner. She stated that the Registrant only did one wash and dress assessment and one practise in the first six weeks of treating him. She informed the Panel that the assessment should have been carried out at least once a week.

177. The Panel was able to identify at least four occasions where the Registrant had conducted a washing and dressing assessment with Patient F. These were on 12 April 2016, 22 April 2016, 24 April 2016, and 4 May 2016. The Panel took the view that a washing and dressing assessment necessarily required the patient to practise washing and dressing. In these circumstances the Panel concluded that the HCPC had not discharged its burden of proof.

178. Accordingly, particular 6(g)(i) and 6(g)(ii) were found not proved.

 

Particular 6(h) – Found Not Proved

‘Spoke in an inappropriate manner to the patient by using words to the effect of “stop bitching” and/or “man up and stop whinging”.

179. Witness JE informed the Panel in her witness statement that a rehabilitation assistant had witnessed the Registrant telling Patient F to ‘stop bitching’ when he raised concerns about moving out of the nursing home into independent living. When the Registrant met with the Therapy Services Manager the Registrant admitted that he had told Patient F to ‘man up and stop whinging.’
 

180. The Panel accepted the evidence of Witness JE. However, the Panel noted that the inappropriate comment and admission as reported by the rehabilitation assistant and Therapy Services Manager was hearsay. There was no statement from either of them, no statement from Patient F and no contemporaneous note of the discussion. In these circumstances the Panel concluded that insufficient evidence had been adduced by the HCPC.

181. Accordingly, particular 6(h) was found not proved.

 

Particular 6(i) – Found Not Proved

‘On an unknown date after you left Birmingham Community NHS Trust, you visited Patient F, without clinical reasoning for doing so;’

182. Witness JE informed the Panel in her witness statement that when the Registrant’s case was escalated internally and to the HCPC the registrant visited the home address of Patient F to ask him to provide a character reference.

183. The Panel accepted that Witness JE relayed the information as she understood it be. However, the Panel noted that the source of the originating information was unknown and therefore hearsay. In these circumstances, the Panel afforded this evidence little weight. There was no statement from Patient F and no contemporaneous note of the discussion from the member of staff within the Trust that spoke to Patient F. In these circumstances, the Panel concluded that insufficient evidence had been adduced by the HCPC.

184. Accordingly, particular 6(i) was found not proved.

Patient G

185. The Registrant took over responsibility of Patient G’s case on 28 April 2016, and he was discharged on 17 June 2016. Patient G suffered with a degenerative spine condition. He was mobile with two crutches. His goals were to improve his left-hand activity. He specifically wanted to be more independent completing kitchen activities.
 
Particular 7(a) – Found Proved

‘Between 28 April 2016 and 17 June 2016, in relation to Patient G you: Did not complete an initial assessment in a timely manner;
186. The Registrant had his first session with Patient G on 29 April 2016. Witness JE informed the Panel in her witness statement that he did not complete the initial assessment until 9 May 2016 which was the date of the fourth session that Patient G had had with him. She stated that the initial assessment should have been completed within the first session with the patient.

187. The Panel accepted the evidence of Witness JE. The Panel was satisfied that there was an unjustified delay in completing the initial assessment and therefore the assessment which was conducted on 9 May 2016, was not timely.

188. Accordingly, particular 7(a) was found proved.

 

Particular 7(b) – Found Not Proved

‘Did not complete and/ or record an adequate treatment plan with rehabilitation goals;’

189. Witness JE informed the Panel in her witness statement that the Registrant did not complete a treatment plan for Patient G at all and therefore had also not recorded any rehabilitation goals. However, she acknowledged in her witness statement and during her oral evidence that it is possible to ‘work out’ what the treatment plan was and the rehabilitative goals.

190. The Panel noted that the Canadian Occupational Performance Measure contained Patient G’s “goals” including personal care, functional mobility and community management goals etc. In addition, the goals are explicitly referred to by the Registrant as “patient goals” in Patient G’s records on 9 May 2016, and were sufficiently comprehensive. In these circumstances, the Panel concluded that the treatment plan was adequate.

191. Accordingly, particular 7(b) was found not proved.
 
Particular 7(c) – Found Proved

‘You did not carry out and/or record an adequate upper limb assessment;’

192. Witness JE informed the Panel in her witness statement that as Patient G wanted to improve left upper limb functional activity, an upper limb assessment should have been carried out by the Registrant. She stated that the upper limb assessment would have identified the issues with Patient G’s upper limb. Her concern was that the Registrant’s assessment was insufficient and did not highlight the nature and extent of Patient G’s problems.

193. The Panel accepted the evidence of Witness JE. The Panel concluded that the assessment that had been conducted was not adequate.

194. Accordingly, particular 7(c) was found proved.

Particular 7(d) – Found Proved

‘On or around 24 May 2016, you used an inappropriate memory strategy “Sun List” with Patient G;’

195. The Registrant visited Patient G on 24 May 2016. The Registrant recorded that ‘we discussed some memory strategies and used the sun list’ strategy to illustrate depth of processing’. Witness JE informed the Panel in her witness statement that the ‘sun list’ is not a recognised assessment and there was no explanation of this assessment method within the notes. She informed the Panel that it was not appropriate to use an unknown strategy. She also stated that Patient G’s neurological condition is a spinal condition and cognitive issues are not associated with this type of neurological condition.

196. The Panel accepted the evidence of Witness JE. The Panel noted that Patient G did not have cognitive problems. The Panel concluded that it was inappropriate to use a strategy which did not relate to the patients presenting clinical condition and rehabilitation needs. The Panel accepted that the ‘sun list’ is not a recognised assessment tool or intervention and so should only have been used with a clear clinical justification and a description. There was no clinical justification in the notes and no description.

197. Accordingly, particular 7(d) was found proved.
 
Patient H

198. Patient H was referred to the Team on 30 March 2016, and his programme concluded on 17 June 2016. He had experienced a stroke at the beginning of December 2015. As a result of the stroke, he had left side inattention. This means he had an inability to acknowledge the environment on his left side. He had poor insight into his condition and how it had affected him; he had poor balance, experienced fatigue and had left-sided weakness.

Particular 8(a) – Found Proved

‘Between 30 March 2016 and 17 June 2016 in respect of Patient H you did not:

Complete and/or record an adequate initial assessment and/or upper limb assessment of Patient H, in a timely manner, or at all’

199. The Registrant’s first appointment with Patient H was on 30 March 2016. Witness JE informed the Panel in her witness statement that although Patient H was cognitively impaired there was no reference to his cognitive abilities in the initial assessment. She also informed the Panel that the Registrant stated during the supervision session that she had with him on 4 April 2016, that he was going to undertake an upper limb measure known as Action Research Arm Test (ARAT). She stated that she reminded him that he should not do any outcome measures until he knew what the problems were, and should first complete an upper limb assessment. The upper limb assessment was undertaken on 19 April 2016.

200. The Panel accepted the evidence of Witness JE that the both the initial assessment and the upper limb assessment lacked sufficient detail. For example, he recorded Patient H’s hand grip to be ‘firm’ and ‘soft’, which did not utilise the standard grading system of 0-5. The Panel concluded that although the Registrant’s initial assessment was timely, it was not adequate, principally because he did not establish an effective baseline measure of the patient’s cognition. The Panel also concluded that the Registrant’s upper limb assessment was neither timely nor adequate. It was inadequate because no effective baseline was established against which the patients progress could be measured.

201. Accordingly, particular 8(a) was found proved.
 
Particular 8(b) – Found Not Proved

‘Did not complete an adequate upper limb referral form in a timely manner;’

202. Witness JE informed the Panel in her witness statement that Patient H was going to attend an upper limb group session. She stated that the allocated occupational therapist is required to complete an upper limb referral form so that the problems are clearly identified and can be addressed during the group session. Witness JE informed the Panel that the form should be completed at least two days prior to the group session, so that it can be reviewed in advance by the person running the group. She stated that the Registrant completed the referral form on the day of the group session when it should have been completed by Friday 13 April 2016.

203. The Panel accepted the evidence of Witness JE. However, as her account of what happened was hearsay the Panel afforded it little weight. There was no corroborative statement from the person running the group and there was no other evidence that the form dated 12 April 2016, was not handed in until the day of the group session. In these circumstances the Panel concluded that insufficient evidence had been adduced by the HCPC.

204. Accordingly, particular 8(b) was found not proved.

Particular 8(c) – Found Proved

Did not complete and/record a treatment plan for Patient H in a timely manner;

205. The treatment plan for Patient H was undated. Witness JE informed the Panel in her witness statement that she was aware that the treatment plan had not been completed by 11 April 2016, because she had noted this in the supervision session that she had with the Registrant on that date.

206. The Panel accepted the evidence of Witness JE. The Panel concluded that the treatment plan was not completed in a timely manner as there was no discernible justification for delaying the completion of the treatment plan until some date after 11 April 2016, when the Registrant’s first appointment with Patient H took place on 30 March 2016. The Panel was satisfied that the treatment plan should have been

51
 

207. Accordingly, particular 8(c) was found proved.

Particular 8(d) – Found Proved

‘In your notes recorded on or around 13 April 2016, you recorded inappropriate comments “to keep grandchildren alive;’

208. One of Patient H’s goals was to return to leisure activities and take his grandchildren to the park. Witness JE informed the Panel in her witness statement that a goal planning meeting took place a few weeks after the patient had been referred to the Team. The Registrant subsequently wrote up the notes of the meeting and under the plan for the patients, family and carers section, he wrote ‘grandchildren to be kept alive.’ Witness JE informed the Panel that when she raised the matter with the Registrant, he said that he thought it was ‘a laugh’ and did not think that it was inappropriate. Witness JE stated during her oral evidence that it was inappropriate and unprofessional.

209. The Panel accepted the evidence of Witness JE. The Panel was satisfied that the Registrant had made the entry in Patient H’s records and that it was inappropriate to do so, even if it was a direct quote from the patient. The Panel took the view that the clinical record of a patient is a formal, professional document and therefore the content is required to meet a professional standard. If the comment was a direct quote from the patient, that should have been made clear by the Registrant.

210. Accordingly, particular 8(d) was found proved.

Particular 8(e)(i) – Found Proved

‘Did not provide and, or any adequate clinical reasoning for:

use of COTNAB with Patient H on or around 08, 11 and/or 19 April 2016;’

211. The Panel took the view that the reference in the stem of 8(e) to “and” can only be sensibly understood as “any”. As such the use of “and” must have been a typographical error. The Panel therefore proceeded on the basis that the particular should read:

“Did not provide any, or any adequate clinical reasoning for: use of COTNAB with Patient H on or around 08, 11 and/or 19 April 2016;”
 
212. The Registrant recorded in his notes dated 8 April 2016, that he used COTNAB with Patient H. Witness JE informed the Panel in her witness statement that the there was no clinical reasoning within the documentation to explain why the Registrant chose to use the COTNAB tasks with Patient H or how they relate to his day to day activities.

213. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant did not provide any clinical reasoning for his use of COTNAB in the entries he made in Patient H’s clinical records on 8 April 2016, 11 April 2016 and 19 April 2016.

214. Accordingly, particular 8(e)(i) was found proved.

Particular 8(e)(ii) – Found Proved

‘Did not provide any, or any adequate clinical reasoning for:
planning to use Rivermead Behavioural Memory Test with Patient H on or around 3 June 2016’.

215. Witness JE informed the Panel in her witness statement that the Rivermead Behavioural Memory Test is used to assess memory. The results can help identify strategies to combat identified memory problems. Witness JE stated that there was no clinical reasoning for the Registrant to use this test given the outcome of other assessments and a discussion with the psychologist.

216. The Panel accepted the evidence of Witness JE. The Panel noted that the Registrant’s entry in the clinical records indicates that it was only after discussing the matter with a colleague that he decided not to try to use the Rivermead Behavioural Memory Test. There is no reference in the notes with regard to his initial rationale for planning to use the test. In these circumstances, the Panel concluded that there was no clinical reasoning for the original plan.

217. Accordingly, particular 8(e)(ii) was found proved.

Particular 8(f) – Found Not Proved

‘Did not identify and/or address Patient H’s cognitive issues in a timely manner;’
 
218. The Panel took into account its findings in relation to particular 8(a). The Panel concluded that the principal inadequacy of the initial assessment was the absence of an effective baseline measure of Patient H’s cognition against which his progress could be measured. The Panel determined that the Registrant’s culpability was encompassed within particular 8(a).

219. Accordingly, particular 8(f) was found not proved Particular 8(g) – Found Proved
‘Inappropriately referred Patient H for a regional driving assessment;’

220. On 25 April 2016, the Registrant recorded the following entry in Patient H’s clinical notes: ‘OT to refer him to RDAC.’ Witness JE informed the Panel in her witness statement that ‘RDAC’ is a centre for regional driving assessments. She stated that as Patient H had clear left side inattention it was not appropriate for the Registrant to make such a referral, as the patient should not be driving given the nature of his impairment.

221. The Panel accepted the evidence of Witness JE. The Panel noted that in addition to his physical impairment, Patient H had cognitive problems and lacked insight with regard to his condition. In these circumstances, the Panel was satisfied that the referral to RDAC was inappropriate.

222. Accordingly, particular 8(g) was found proved.

Particular 8(h) – Found Proved

‘Did not appreciate the risk and/or conduct an appropriate risk assessment in relation to Patient H using a lawnmower;’

223. Witness JE informed the Panel in her witness statement that during the supervision session that took place on 26 April 2016, she raised with the Registrant the appropriateness of the tasks that he was considering for Patient H. She stated that the occupational therapy goals for Patient H included ‘small gardening jobs’ which would mean gardening and weeding given that he had a lot of pain in his shoulder. Witness JE expressed concern that the Registrant thought that mowing the lawn might
 
be an appropriate activity. She stated that the movement of pushing the lawnmower was likely to have aggravated the patient’s pain.

224. The Panel accepted the evidence of Witness JE. The Panel was satisfied that there was no evidence from within the supervision note or clinical records to indicate that the Registrant appreciated the risk and there was no evidence that a risk assessment had been conducted.

225. Accordingly, particular 8(h) was found proved.

Particular 8(i) – Found Proved

‘Did not appropriately consider rest periods for Patient H between OT sessions;’

226. Witness JE informed the Panel in her witness statement that Patient H experienced fatigue and that the Registrant often did not consider this factor when arranging sessions. She stated that on occasions the Registrant did two sessions in a day (morning and afternoon) with Patient H and did back to back sessions. Witness JE referred the Panel to the supervision session that she had with the Registrant on 21 April 2016, where this issue was discussed.

227. The Panel accepted the evidence of Witness JE. The Panel noted that during the supervision session the Registrant was advised to ensure that patients have appropriate rest periods. The Panel was satisfied that the Registrant did not appropriately consider rest periods for Patient H between occupational therapy sessions.

228. Accordingly, particular 8(i) was found proved.

Particular 8(j) – Found Not Proved

‘Made inappropriate comments about Patient H trying for a baby.’

229. Witness JE informed the Panel in her witness statement that a review meeting took place on 11 May 2016, which was confirmed by the clinical records. The meeting was attended by the Registrant, Patient H and a physiotherapist. Although Witness JE was not present she reported that she was informed that during the meeting the Registrant said, ‘did you tell the physio your news…that you were going to try for
 
another baby…’. Witness JE stated that this was a completely inappropriate comment to make because Patient H was in his 70’s with a cognitive impairment and would not have understood it to be a joke. She stated that when the Registrant was confronted by the physiotherapist, he said that it was a joke.

230. The Panel accepted the evidence of Witness JE. However, as her account of what took place was hearsay the Panel afforded it little weight. There was no statement form the physiotherapist and no contemporaneous note of the conversation that took place between the physiotherapist and the Registrant with regards to the comment. In these circumstances, the Panel concluded that insufficient evidence had been adduced by the HCPC.

231. Accordingly, particular 8(j) was found not proved.

 

Patient I

 

232. The Registrant initially saw Patient I on 8 April 2016, and his final session with the patient was on 23 May 2015. Patient I had experienced a stroke. Prior to the stroke the patient was fully independent and lived by herself. As a result of the stroke, she was experiencing left sided weakness, but she was not cognitively impaired. Her main issues were around mobility. She needed assistance getting in and out of her home and help with meal preparation as a result of her limited ability to use her left arm.

 

Particular 9(a) – Found Proved

‘Between 01 April 2016 and 28 June 2016, in respect of Patient I you:

Did not adequately address Patient I’s upper limb rehabilitation goals including on or about 19 and/or 25 April 2016, practised handwriting with Patient I’s non–dominant hand prior to considering rehabilitation.’

233. The Registrant visited Patient I on 19 April 2015, and 25 April 2016. Witness JE informed the Panel in her witness statement that during the two sessions the Registrant carried out handwriting practice with the patient. He encouraged her to use her non-dominant hand which was not affected by the stoke. Witness JE’s criticism of
 
the Registrant was on the basis that his focus should have been on establishing the rehabilitative potential of Patient I’s dominant hand rather than providing compensatory treatment.

234. The Panel accepted the evidence of Witness JE. The Panel noted that compensatory treatment was not inappropriate but as part of the intensive rehabilitation programme the Registrant should have prioritised improved function in Patient I’s affected hand and it was to that extent that his upper limb rehabilitation goals were not adequate.

235. Accordingly, particular 9(a) was found proved.

 

Particular 9(b) – Found Proved

‘Between 01 April 2016 and 28 June 2016, in respect of Patient I you:

Did not provide any or any adequate clinical reasoning for using COTNAB.’

236. Witness JE informed the Panel in her witness statement that the purpose of using COTNAB is to review the cognitive ability of a patient. The Registrant recorded in his notes dated 19 April 2016, that he used a COTNAB task with Patient I. Witness JE stated that the there was no clinical reasoning within the documentation to explain why the Registrant chose to use the COTNAB tasks with Patient I, given that no cognitive impairment had been identified.

237. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant did not provide any clinical reasoning for his use of COTNAB in the entries he made in Patient I’s clinical records on 19 April 2016.

238. Accordingly, particular 9(b) was found proved.

 

Patient J

239. The Registrant’s first appointment with Patient J was on 2 November 2015 and he was discharged from the Team on 16 February 2016. Patient J had suffered a stroke and had chronic renal failure. He was required to have dialysis three times a
 
week which limited his occupational therapy interventions to three times a week. He experienced fatigue as a result of the dialysis. In addition, he had cognitive problems and dyspraxia.
Particular 10(a) – Found Proved

‘Between 23 October 2015 and 16 February 2016, in respect of Patient J you:

Did not complete and/or record an adequate initial assessment and/or treatment plan, in a timely manner;’

240. Witness JE informed the Panel in her witness statement that although the Registrant’s visit with Patient J was on 2 November 2015, the initial assessment and treatment plan was not completed until 29 January 2016. She stated that the documents were completed many weeks after the treatment had commenced. Witness JE was also critical of the content of the initial assessment, which she described as ‘very brief’. She stated that the Registrant recorded that the patient’s cognition had ‘been affected’ but no further information was provided. There was also scant detail of the patient’s home environment, and no information explaining why ‘no’ and ‘none’ were entered under the sections relating to ‘accessing community’ and ‘leisure’. In addition, there was no information relating to Patient J’s carers.

241. The Panel accepted the evidence of Witness JE. The Panel concluded that the Registrant’s note contained insufficient detail and was therefore an inadequate record. As the initial assessment and treatment plan were not completed until more than 10 weeks after the first appointment, the initial assessment and treatment plan were not completed in a timely manner.

242. Accordingly, particular 10(a) was found proved.

Particular 10(b) – Found Proved

‘Did not complete and/or record an upper limb assessment of Patient J;’

243. Witness JE stated in her witness statement that in order to address the issues relating to Patient J’s weakened arm and dyspraxia, an upper limb assessment had to
 
be completed. She stated that this was the Registrant’s responsibility as the allocated occupational therapist but there was no evidence that the assessment was completed.

244. The Panel accepted the evidence of Witness JE. The Panel was satisfied that there was no evidence that an upper limb assessment had been completed and concluded that it had not been done.

245. Accordingly, particular 10(b) was found proved.

Particular 10(c) – Found Not Proved

‘Did not address Patient J’s cognitive issues in a timely manner;’

246. Witness JE informed the Panel in her witness statement that the Registrant had recorded that Patient J had cognitive problems in January 2016, but this was two months after his initial appointment with the patient on 2 November 2015.

247. However, the Panel noted that the Registrant used COTNAB testing to review the patient’s cognitive ability on 9 November 2015, and 12 November 2015, which was completed on 16 November 2015. In these circumstances, the Panel concluded that the Registrant had addressed Patient J’s cognitive issues and as they were considered within two weeks of his initial appointment, it could not properly be characterised as untimely.

248. Accordingly, particular 10(c) was found not proved.

 

Particular 10(d)(i), 10(d)(ii) and 10(d)(iii) – Found Proved

‘Your clinical notes lacked clinical reasoning in respect of sessions with Patient J on or around:

i. 09 November 2015;

ii. 11 November 2015;

iii. 16 November 2015.’

249. Witness JE informed the Panel in her witness statement that the Registrant had not identified Patient J’s cognitive problems during the first appointment which took
 
place on 2 November 2015. She acknowledged that the Registrant had used COTNAB testing on 9 November 2015, 11 November 2015, and 16 November 2015 but stated that there is no clinical reasoning within the clinical notes. She stated that he did not provide any explanation for the use of the particular tests, why it was appropriate for Patient J or how it related to his day to day functioning.

250. The Panel accepted the evidence of Witness JE. The Panel noted that her reference to 11 November 2015, was more likely to be 12 November 2015. The Panel was satisfied that the Registrant’s entries in Patient J’s records provide no clincal reasoning justifying the rationale and appropriateness of his use of the COTNAB tests.

251. Accordingly, particular 10(d)(i), 10(d)(ii) and 10(d)(iii) were found proved.

 

Particular 10(e) – Found Proved

‘Did not appreciate the risks associated with playing table tennis with the patient in the ward garden.’

252. The Registrant planned to play table tennis with Patient J by setting up a full- size table in the physiotherapy gym. As this arrangement affected other therapists and patients that had already booked to use the gym, he was asked to reschedule the activity. Witness JE was critical of the content of the Registrant’s email, dated 4 February 2016, in which he stated that ‘next week we will do the table tennis session in the…garden.’ She stated that it was the middle of winter, the ground was wet and covered in leaves and the patient had mobility problems. For these reasons she stated that it would have been unsafe to carry out the session outdoors.

253. The Panel accepted the evidence of Witness JE. The Panel was satisfied that the Registrant’s email did not demonstrate any appreciation for the risks associated with conducting the leisure activity outdoors given the patient’s medical and physical problems.

254. Accordingly, particular 10(e) was found proved.
 
Patient K

 

255. The Registrant carried out his initial session with Patient K on 12 January 2016. Patient K had an infection of the brain tissue which resulted in weakness in his arms and legs. Patient K did not have cognitive problems.

Particulars 11(a)(i), 11(a)(ii) and 11(a)(iii) – Found Proved

‘Between 12 and 28 January 2016, in respect of Patient K you:

Did not record progress notes in a timely manner in relation to visits completed on or around:

i. 13 January 2016;

ii. 15 January 2016;

iii. 19 January 2016.’

256. Witness JE informed the Panel in her witness statement that the Registrant completed a visit with Patient K on 13 January 2016, 15 January 2016 and 19 January 2016 which were not recorded until the afternoon of 21 January 2016. She stated that none of the recordings complied with the Trust’s Clinical Record Keeping Policy.

257. The Panel accepted the evidence of Witness JE. The Panel noted that the Trust’s policy required records to be made as soon as possible and within a maximum of 24 hours of the contact with the patient. The Panel was satisfied that none of the relevant recordings were made with the required time-frame and there was no evidence before the Panel that this was for good reason.

258. Accordingly, particulars 11(a)(i), 11(a)(ii) and 11(a)(iii) were found proved.

Decision on Grounds

 Panel’s Approach

259. In view of the Panel’s factual findings the Panel went on to consider the issue of grounds but only in relation to the particulars that were found proved. No further
 
consideration was given to the particulars that were found not proved. The Panel was aware that determining the issue of lack of competence and/or misconduct is a matter of judgement; there is no standard of proof.

260. The Panel took into account the submissions of Ms Thompson and accepted the Legal Assessor’s advice.

261. The Panel was aware that lack of competence can be distinguished from misconduct in that it indicates an inability to work at the required level and connotes a standard of professional performance which is unacceptably low which has usually been demonstrated by reference to a fair sample of the Registrant’s work. The Panel also noted that negligence may amount to misconduct if it is sufficiently serious. The Panel was aware that a breach of the standards alone does not necessarily constitute misconduct. The Panel also bore in mind the explanation of that term given by the Privy Council in the case of Roylance v GMC (No.2) [2000] 1 AC 311 where it was stated that:

“Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a … practitioner in the particular circumstances. The misconduct is qualified in two respects. First, it is qualified by the word ‘professional’ which links the misconduct to the profession ... Secondly, the misconduct is qualified by the word ‘serious’. It is not any professional misconduct which will qualify. The professional misconduct must be serious.”

 

Decision

Lack of Competence

262. The Panel noted that the Registrant appeared to have worked effectively and competently as an occupational therapist for a significant period as he was employed by the Trust for approximately 16 years. The relevant difficulties arose during a period between December 2015 and June 2016, three months after the Registrant was rotated into the Team.
 
263. The Panel was satisfied that the majority of its factual findings relate to deficiencies which are core competencies for an occupational therapist. Although the Registrant must have been capable of working to the required standard during his career there was no information before the Panel to fully explain the decline in the quality of his clinical practice. The Registrant’s health condition was a life-long condition and did not appear to adequately explain the decline. The Panel noted that the Trust implemented its formal performance review process rather than its disciplinary procedures and took this into account in determining that most of the factual findings relate to deficient professional performance. The Panel accepted Witness JE’s evidence that the Registrant required an increased level of supervision that would not normally be required for a first- or second-year student, let alone a Band 6 occupational therapist.

264. The Panel concluded that the factual findings fell within the following overarching themes as identified by the Trust:
• Timely documentation;
• Clinical reasoning;
• Clinical knowledge;
• Planning and prioritisation of occupational therapy goals;
• Ability to follow the Team’s procedures.

265. The Panel took the view that the Registrant’s performance in his role as a Band 6 occupational therapist represented a significant departure from the following HCPC Standards of Proficiency 2013, which state that registrants must:

1. be able to practise safely and effectively within their scope of practice;
3. to be able to maintain fitness to practise;
4. be able to practise as an autonomous professional, exercising their own professional judgement;
8. be able to communicate effectively;
10. be able to maintain records appropriately;
14. be able to draw on appropriate knowledge and skills to inform practice;
15. understand the need to establish and maintain a safe practice environment

266. The Panel was satisfied that overall the quality of the Registrant’s practice was unacceptably low, and that Patients A-K represented a fair sample of his work. The
 
Panel concluded that the Registrant’s inability to meet this standard consistently, despite considerable support and assistance, demonstrated that his performance was well below the standard expected of a registered practitioner.

267. The Panel concluded that the Registrant’s deficient skills and knowledge were fundamental to safe and effective practice as an occupational therapist and could be properly described as a lack of competence.

Misconduct

268. The Panel took the view that the only factual finding that amounted to misconduct was particular 8(d) relating to the inappropriate comment ‘to keep grandchildren alive.’

269. The Panel noted that the Registrant’s patients were particularly vulnerable because although they had rehabilitation potential, he was responsible for service users that had neurological disabilities, for example, patients who had suffered stokes, spinal injury, traumatic brain injury, neuropathies and multiple sclerosis. In these circumstances, communication skills are particularly important. The Panel took the view that it was highly inappropriate to record a ‘joke’ in a patient’s clinical notes. Even if it was an expression of humour made by the patient himself, if it was relevant and appropriate to include within the notes, it was important for it to be contextualised. There was no context to the comment which had the potential to be shared not only with the patient, but his family and other professionals.

270. The Panel considered the HCPC Standards of Conduct, Performance and Ethics [2012 and 2016 versions] and was satisfied that the Registrant’s conduct breached the following 2016 standards:

• 9.1 - You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.

• 10.1 - You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to.
 
271. The Panel was aware that a breach of the standards alone does not necessarily constitute misconduct. However, the Registrant’s conduct and behaviour fell far below the standards expected of a registered practitioner. The Registrant was an experienced occupational therapist and although it may have been a momentary failure or a temporary lapse of judgement, the Panel concluded that it was sufficiently serious to be characterised as misconduct.

 

Decision on Impairment

 Panel’s Approach

272. Having found lack of competence and misconduct the Panel went on to consider whether the Registrant’s fitness to practise is currently impaired. The Panel took into account the HCPTS Practice Note: “Finding that Fitness to Practise is Impaired” and accepted the advice of the Legal Assessor.

273. The Panel took into account the submissions of Ms Thompson, on behalf of the HCPC.

274. In determining current impairment, the Panel had regard to the following aspects of the public interest:

• The ‘personal’ component: the current competence, behaviour etc. of the individual registrant; and

• The ‘public’ component: the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession.

 

 Panel’s Decision

275. The Panel considered the Registrant’s current fitness to practise firstly from the personal perspective and then from the wider public perspective.
 
276. The Panel noted that there has been no engagement from the Registrant since the investigation stage was completed. As a consequence, there was no evidence before the Panel that he fully appreciates the gravity of his failings, there was no explanation as to how he would behave differently in the future and no assurance that the clinical deficiencies have been remedied and would therefore not be repeated. In particular there was no evidence before the Panel that the Registrant has brought his clinical skills up to date. In the absence of any insight and any steps he has taken towards remediation since the events of 2015 and 2016, the Panel concluded that there is a real risk of repetition. The Panel was particularly concerned by the persistent nature of the Registrant’s failings and the inability to make sufficient improvements despite considerable support and supervision.

277. The Panel took the view that the factual findings raise serious public safety concerns. The Registrant demonstrated a persistent inability to make or maintain improvements to his clinical practice which did put vulnerable patients at risk of harm. The Registrant has shown no insight and, although lack of competence is usually capable of being remedied, there is no basis on which the Panel could conclude that any form of remediation has begun. In the absence of any evidence of remediation and insight the Panel took the view that there is a current and ongoing risk of harm to patients.

278. The Panel concluded that, in these circumstances, the Registrant’s fitness to practise is currently impaired based on the personal component.

279. In considering the public component, the Panel had regard to the important public policy issues which include the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour.

280. A significant aspect of the public component is upholding proper standards of behaviour. Members of the public would be extremely concerned to learn that an occupational therapist working with vulnerable patients was unable to work as an autonomous practitioner, as this clearly has the potential to compromise the safety and well-being of patients. The Registrant’s conduct fell far below the standard expected of a registered occupational therapist and
 
the Panel concluded that until the Registrant has remediated his wrongdoing, he continues to pose a risk to patients. The Panel also concluded that a finding of no impairment would fail to declare and uphold proper standards, would undermine confidence in the profession of occupational therapy and would undermine public confidence in the HCPC as a professional regulator, particularly given the wide-ranging deficiencies in the Registrant’s practice.

281. In all the circumstances, the Panel determined that public trust and confidence would be undermined if a finding of impairment is not made.

282. The Panel concludes that the Registrant’s current fitness to practise is impaired on the basis of both the personal component and the wider public interest and therefore the HCPC’s case is well-founded.

Sanction

Submissions

283. Ms Thompson referred the Panel to the Indicative Sanctions Policy (ISP) and reminded the Panel that its primary function is to protect the public and the wider public interest. She made no positive submission with regard to the sanction that should be imposed. However, Ms Thompson suggested that no action or imposition of a Caution Order would be insufficient given the Registrant’s serious and persistent failings, the risk to service users, the lack of insight and remediation and the risk of repetition. Therefore, she invited the Panel to consider the remaining options from a Conditions of Practice Order onwards.
 Panel’s Approach

284. The Panel accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of any sanction is not to punish the Registrant, but to protect the public and the wider public interest. The public interest includes maintaining public confidence in the profession and the HCPC as its regulator and by upholding proper standards of conduct and behaviour. The Panel noted that all of the sanction options were available, as it had made a finding of misconduct. However, the Panel was mindful that this was
 
predominantly a lack of competence case and, that in cases solely relating to lack of competence, a Striking Off Order is not available.

285. The Panel applied the principle of proportionality by weighing the Registrant’s interests with the public interest and by considering each available sanction in ascending order of severity.

286. The Panel had regard to the ISP and took into account the submissions made by Ms Thompson.

 

 

 Panel’s Decision

287. The Panel at the outset of its deliberations considered the aggravating and mitigating factors.
288. The Panel identified the following aggravating factors present in this case:
• the Registrant demonstrated an inability to make or maintain improvements to his clinical practice despite significant support and supervision;
• the Registrant demonstrated a resistance to the formal performance review procedure implemented by the Trust;
• the Registrant’s failings were wide-ranging, serious and persisted for a significant period of time in relation to multiple patients;
• as a consequence of the Registrant’s acts and omissions particularly vulnerable patients were exposed to a risk of harm which was unnecessary and avoidable. The potential risks included unjustified delays to patients’ intensive rehabilitation, inadequate planning and prioritisation and inadequate clinical reasoning, all of which had an adverse impact on the patients’ progress and potential outcome;
• the Registrant has shown no insight, remorse or remediation;
• there is an ongoing risk of repetition.
 
289. The only mitigating factor the Panel was able to identify was the absence of any previous fitness to practise history. The Panel noted that the Registrant rotated to a new role in the Trust’s Neuro-Rehabilitation Team requiring the treatment of patients needing short-term intensive rehabilitation. This differed from his previous role. However, this was not a mitigating factor as the Registrant ought to have been able to demonstrate core competencies, regardless of his clinical role.
No Action

290. Having taken the aggravating and mitigating factors into account the Panel first considered taking no action. The Panel concluded that, in view of the nature and seriousness of the Registrant’s lack of competence and misconduct which has not been remedied, and in the absence of exceptional circumstances, it would be inappropriate to take no action. Furthermore, it would be insufficient to protect the public, maintain public confidence and uphold the reputation of the profession.
Caution Order

291. The Panel then considered a Caution Order. The Panel noted that although Caution Orders appear on the Register, they do not restrict a registrant’s ability to practise and took into account paragraph 28 of the ISP which states:
“A caution order is an appropriate sanction for cases, where the lapse is isolated, limited or relatively minor in nature, there is a low risk of recurrence, the registrant has shown insight and taken appropriate action…A caution order is unlikely to be appropriate in cases where the registrant lacks insight.”

292. The Registrant’s persistent inability to meet the standards required of a competent occupational therapist was not minor in nature or limited. Furthermore, the Registrant has not demonstrated that any of the skills and knowledge, relevant to safe and competent practice have been addressed, nor has he demonstrated any insight and as a consequence there is an ongoing risk of repetition. In any event, the deficiencies in the Registrant’s practice had the potential to have wide-ranging adverse consequences and therefore some
 
restriction on his practise is required. Consequently, the Panel concluded that a Caution Order would be inappropriate and insufficient to protect service users and meet the public interest.
Conditions of Practice Order

293. The Panel went on to consider a Conditions of Practice Order. The Panel took the view that the Registrant’s deficiencies are capable of being remedied and was satisfied that, in theory, appropriate, workable conditions could be formulated. However, the Panel noted that paragraph 33 of the ISP 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 or denies any wrongdoing;

• where there are serious or persistent overall failings;’

294. The Panel took the view that the Registrant may be able to improve his skills and knowledge base by attending a programme similar to a Return to Work programme for practitioners, who have been out of practice for a significant period of time, which may take the form of formal courses, informal learning and/or work placements. However, a Conditions of Practice Order requires a willingness on the part of the Registrant to remediate his practice and to comply with any conditions imposed because attending courses and training is only the starting point. It is the learning and development that has been achieved as a result of the course or training that is of critical importance and how it has been, or will be, translated into good practice. Furthermore, the Panel noted that the Registrant had been unable to demonstrate sufficient progress when he was made subject to the Trust’s formal performance review process and, in accordance with the evidence of
 
Witness JE, became resistant to the process and increasingly disruptive and angry in the workplace.
295. The Panel concluded that given the Registrant’s failure to engage with the regulatory process and the resulting failure to provide any evidence that he has developed the skills and knowledge necessary to perform the role of an occupational therapist to a competent standard, or that he is willing to do so, the Panel could have no confidence that he would comply with a Conditions of Practice Order. In the absence of any evidence of commitment and readiness to prioritise a return to occupational therapy practise the Panel concluded that there were no conditions it could impose which would be workable or appropriate.
Suspension Order

296. Having determined that a Conditions of Practice Order would not be appropriate, the Panel concluded that the appropriate sanction is a Suspension Order. A Suspension Order would send a signal to the Registrant, the profession and the public re-affirming the standards expected of a registered occupational therapist. The Panel took the view that a Suspension Order would prevent the Registrant from practising during the suspension period, which would therefore protect the public and the wider public interest. In addition, a Suspension Order would adequately mark the seriousness of the Panel’s finding of a serial lack of competence and the misconduct in relation to the inappropriate comment. In reaching this conclusion, the Panel was mindful that, although it had made a finding of misconduct, this case was primarily a lack of competence case. Furthermore, the misconduct finding would not, in itself, justify a Striking Off Order.
297. The Panel determined that the Suspension Order should be imposed for a period of 12 months. The Panel was satisfied that this period was appropriate to mark the seriousness of the Registrant’s lack of competence and misconduct and would provide sufficient time for the deficiencies in his clinical practice to be addressed. In imposing the
 
maximum 12-month period, the Panel noted that the Registrant had been unable to demonstrate sufficient improvement to his practise during the Trust’s formal performance review process, despite intensive support and supervision. Therefore, the suspension period reflects the amount of time that the Registrant may need to reflect on the Panel’s findings and devise a plan of action targeted towards a return to practice.
298. The Panel determined that the appropriate and proportionate order is a 12-month Suspension Order. The Panel noted that a Striking Off Order may not be made in respect of an allegation relating to lack of competence unless the registrant has been continuously suspended, or subject to a Conditions of Practice Order, for a period of two years at the date of the decision to Strike Off. Although this Panel cannot bind a future review panel, a failure to take the opportunity to demonstrate insight and remediation would be likely to result in a Striking Off Order at some point in the future.
299. The Suspension Order will be reviewed shortly before expiry. However, the Registrant may request an early review before the mandatory review, if he believes that he is able to demonstrate that he has made sufficient progress which would justify the order being varied, replaced or revoked.
300. A future reviewing panel would expect the Registrant to attend the review hearing and provide evidence that he has undertaken significant steps that would facilitate a safe and effective return to practise, which may include:
(i) Evidence that the Registrant has reflected on the Panel’s findings;

(ii) Evidence that the Registrant has developed his occupational therapy skills and knowledge through:
• Short courses (online or otherwise) and/or
 
• Seminars, and/or

• Reading journals, and/or

• Volunteering or work shadowing;

(iii) Testimonials/references (paid or unpaid roles) from individuals able to comment on the Registrant’s skills and knowledge relevant to occupational therapy role;
(iv) Any relevant medical evidence from a GP or other suitably qualified practitioner.

 

That the Registrar is directed to suspend the registration of Peter D Thorneycroft for a period of 12 months from the date this order comes into effect.

 

No notes available

History of Hearings for Mr Peter D Thorneycroft

Date	Panel	Hearing type	Outcomes / Status
04/12/2019	Conduct and Competence Committee	Review Hearing	Struck off
12/11/2018	Conduct and Competence Committee	Final Hearing	Suspended