Mr Gareth E Williams
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Between 11 March 2013 and 18 November 2014, during the course of your employment as a Speech and Language Therapist by the Dudley Group NHS Foundation Trust:
1. On or around the 02 October 2014, during and/or following a visit to Patient B:
i. you did not contact the GP service to update them of the outcome of a second food trial;
ii. you did not record complete clinical notes in relation to the visit, within the required timescales;
iii. you contacted the GP service and discussed ‘feed at risk’ and/or ‘enteral feeding’ without getting advice from a senior speech and language therapist;
iv. you did not document a telephone call with a senior speech and language therapist and/or the clinical advice which was given;
v. you did not set goals within your follow up notes;
vi. you did not record the outcome of the session in the East Kent Outcome System (EKOS).
2. You did not keep accurate and/or contemporaneous records, in that:
a) In or around October 2013 or November 2013, in relation to Patient C, you recorded the patient had declined an assessment when this was incorrect.
b) Between August and November 2014 you did not record complete notes for the following patients in a timely manner;
i. Patient H;
ii. Patient I;
iii. Patient J;
iv. Patient K.
c) On or around 9 October 2013 you duplicated notes for Patient L.
d) In relation to Patient I, you did not document when the following were sent:
i. a letter sent to the GP.
ii. a fax sent to the GP. 3
e) Following a visit to Patient G on or around 9 April 2014, you did not complete the patient follow up document within 24 hours.
3. In or around October 2014, you inappropriately took home patient notes belonging to Patients D, E and/or F.
4. The matters described in paragraphs 1 – 3 constitute misconduct and/or lack of competence.
5. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Registrant’s first, post qualification, employment was with the Dudley Group NHS Foundation Trust (the Trust) as a Speech and Language Therapist (SLT), which started on 11 March 2013.
2. The Registrant’s post as a Band 5 SLT included 6 monthly rotation through various clinical specialties. The rotation commenced in May 2013. Mr Williams’ first rotation was working across ‘acute in-patient stroke wards’ for 1 day per week and 3 days in community services where his clinical caseload included working with patients in a clinic setting and in their homes. During this rotation the community SLT services transferred to a new multi-disciplinary service, Dudley Rehabilitation Service, which remains part of the Dudley Group, and, as his rotation was in part with community service, the Registrant moved with the rest of the SLT team.
3. The Registrant was responsible for assessing, treating and managing adult patients with communication disorders and, once he had completed his post graduate dysphagia training, this also included patients with swallowing difficulties.
4. Concerns were first raised about the Registrant’s note keeping in October 2013 and therefore Stage 1 Capability Proceedings commenced in accordance with the Trust Capability Policy. To support the Registrant’s development it was decided to reduce patient contact and supervision was increased to weekly structured supervision.
5. On 8 November 2013, concerns were raised that the Registrant’s record keeping was not up to SLT standards. In his notes for Patient C, he recorded that the patient had declined an assessment and that the visit had ended early. On investigation, however, it transpired that the Registrant in fact was late in arriving for the visit and did not undertake the assessment (this is the subject of particular 2(a)). On 13 November 2013, the Registrant admitted that this record was not a true reflection of events.
6. As a result of this matter coming to light, in December 2014 a review of the Registrant’s caseload was undertaken. This revealed that a number of entries in patients’ records had not been made contemporaneously with appointments.
7. Standing Operating Procedure (SOP) stipulates that ‘records should be written as soon as possible after an event has occurred (but not later than 24 hours) to ensure information is current and accurate.’
8. Upon examination of the Registrant’s work, shortcomings were found in areas of record keeping, follow up of appointments, and information security.
9. The Registrant was suspended from work on 3 October 2014.
10. These matters were referred to the HCPC and formed the subject of the Allegations, which were found proved at the final hearing held on 22 – 22 February 2017. The substantive panel found that the factual particulars amounted to lack of competence, but did not amount to misconduct.
11. Ms Simpson, on behalf of the HCPC, outlined the background of the case and the previous hearing reviews to the Panel. She pointed out that the Registrant had changed his career and had not taken steps to demonstrate remediation in accordance with the conditions imposed upon his practice. She submitted that the Registrant’s fitness to practise remains impaired.
12. Mr Williams gave evidence on oath. He told the Panel that he had changed his career and that he did not envisage returning to being a SLT in the foreseeable future - meaning not for at least 10 years. He pointed out that he had not completed his first year as a newly qualified practitioner, something that was required by the Royal College of Speech and Language Therapists. He said that whilst he had changed his career and was settled on his new career path, he did not want to rule out the option of returning to the profession in later life. Mr Williams acknowledged that he would require extensive retraining before he would be able to consider returning to the profession.
Panel’s considerations and decision
13. The Panel accepted the advice of the Legal Assessor.
14. The Panel first considered whether the Mr Williams’ fitness to practise is currently impaired, and it reminded itself of the guidance found in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin).
15. The Panel took into consideration the oral evidence of Mr Williams and the submissions of Ms Simpson.
16. In coming to its decision, the Panel noted that Mr Williams had engaged and remained engaged with this process. However, in the light that he has not taken active steps to remediate the short-comings in his practice, the Panel determined that his fitness to practise remained impaired. The Panel accepts that Mr Williams has had a career change and was not working as an SLT. However, condition 9 (relating to the maintenance of the RCSLT CPD log) did not require employment as an SLT. Mr Williams could have taken steps to read online journals to maintain parts of his knowledge as an SLT.
17. In the light of the above, the Panel determined that Mr Williams’ fitness to practise remains impaired by reason of his un-remediated lack of competence.
18. Having determined that Mr Williams’s fitness to practice remained impaired by reason of his lack of competence the Panel went on to consider what action to take today. The Panel took into account the HCPC’s Indicative Sanctions Policy document and considered its powers under Article 30(1).
19. The Panel also took into account the fact that Mr Williams has indicated that he did not wish to practise as an SLT for the foreseeable future but that he might wish to return to the profession outside the foreseeable future. The Panel reminded itself that if a Registrant wished to remain on the HCPC register, it is incumbent upon him to comply with the requirements for registration. One of those basic requirements is to maintain his CPD.
20. In the light of the information before it, the Panel determined that Mr Williams did not have a settled commitment to remaining in the profession.
21. The Panel first considered taking no further action and allowing the Order to lapse upon expiry. The Panel determined that this was not appropriate as the Registrant’s fitness to practise remains impaired and taking no action would neither protect the public nor be in the public interest.
22. The Panel went on to consider whether to impose a Caution Order upon the expiry of the current order. The Panel considered that the imposition of a Caution Order would serve no useful purpose as Mr Williams has stated that he did not intend to return to the profession within five years, which is the maximum duration of a Caution order. It would also not protect the public.
23. The Panel next considered maintaining the current Conditions of Practice Order. However, in the light of Mr Williams’ change of career, and there not being a settled commitment to remaining in the profession, the Panel also determined that a Conditions of Practice Order would serve no useful purpose. The Panel noted that Mr Williams had not kept his CPD up to date, and there is no indication that he intends to do so going forward. This would be one of the requisite Conditions of Practice, and the Panel was not satisfied that Mr Williams would comply with this.
24. The Panel therefore determined that the only appropriate course at this stage that would protect the public and the public interest, was to suspend Mr Williams’ registration as an SLT.
25. The Panel determined that the appropriate period of suspension in this case was 12 months. This is for the following reasons:
(a) It would allow Mr Williams sufficient time to consider whether he maintained a commitment to remaining in the profession. If he did, then he should at least complete the minimum CPD requirements, as he is able to whilst on suspension, to demonstrate such commitment to the next reviewing panel;
(b) It would allow sufficient time for all sanction options to be available to the next reviewing panel if the situation remains unchanged.
(c) It would allow for alternative methods of removal from the register to be explored, and the terms of those methods. It must be borne in mind that this is a case involving a lack of competence and not misconduct, and that there are Return to Practice requirements that are part of the HCPC registration process, and which are designed to protect the public and to maintain confidence in the profession.
The Registrar is directed to replace the Conditions of Practice Order with a Suspension Order for a period of 12 months on the expiry of the existing Order.
This Order will be reviewed before its expiry.
History of Hearings for Mr Gareth E Williams
|Date||Panel||Hearing type||Outcomes / Status|
|09/11/2018||Conduct and Competence Committee||Review Hearing||Hearing has not yet been held|
|07/09/2018||Conduct and Competence Committee||Final Hearing||Suspended|
|22/08/2018||Conduct and Competence Committee||Final Hearing||Adjourned|
|20/02/2017||Conduct and Competence Committee||Final Hearing||Conditions of Practice|