Miss Ruth E Yorkston

Profession: Occupational therapist

Registration Number: OT32791

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 17/04/2019 End: 17:00 17/04/2019

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

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

The following allegation was considered by a Panel of the Conduct and Competence Committee at the substantive hearing on 19 – 21 April 2016 and 18 – 19 April 2017

During the course of your employment as an Occupational Therapist for Tees, Esk and Wear Valleys NHS Foundation Trust between April 2010 and February 2012, you:
1) Did not demonstrate adequate clinical reasoning and/or skills in that you:
a) Were unable to demonstrate an adequate understanding of the MOHOST tool and/or its rating system.
b) Were unable to demonstrate an adequate understanding of the Mayers Lifestyle Questionnaire.
c) In relation to Case 1:
i) You did not specify height measurements in relation to a bath, toilet and/or bed; Not found proved
ii) You did not provide any/or adequate indication of whether the heights referred to at 1c)i) might pose a problem for the Service User post-surgery; Not found proved
iii) You did not contact the acute hospital about any help they could provide the Service User following her planned surgery. Not found proved
d) In relation to Case 3, on 25 October 2011 recorded a plan to visit the Service User for food shopping on 2 November 2011 but did not state why you had selected this activity in the notes.
e) In relation to Case 4, on or around 25 October 2011 you made an entry in the notes which was fragmented and/or did not make sense.
f) In relation to Case 5:
i) Your entry dated 19 October 2011 was unclear, in that it did not specify what further assessment was to be undertaken;
ii) On 1 November 2011, the information you recorded in relation to a cooking assessment of the Service User did not state how he managed the process and/or whether he was able to continue cooking for himself;
iii) Your entry relating to contact which took place on 9 November 2011 was unclear and/or fragmented.
g) In relation to Case 8:
i) Following a home visit on 25 November 2011 you noted that the Service User wanted to have his teeth removed but did not take any/any adequate steps to clarify whether this was a genuine need or a possible symptom of his mental health;
ii) Your plan, recorded following a home visit on 25 November 2011, did not adequately address the Service User’s needs.
h) In relation to an OT assessment you observed on 6 October 2011 you produced a reflective log but did not include all relevant information.
i) In relation to an OT assessment you observed on 19 October 2011 you produced a reflective log which did not include all relevant information.
2) Did not complete follow-up actions in that:
a) In relation to Case 1, you did not contact and/or did not adequately record your contact with the Service User's Care Coordinator as planned:
i) following a telephone conversation with the Service User on 3 November 2011;
ii) following a home visit to the Service User on 8 November 2011;
iii) until prompted in supervision on 17 November 2011.
b) In relation to Case 1, you did not make and/or record appropriate enquiries into the Service User’s potential vulnerability on:
i) 3 November 2011;
ii) 8 November 2011.
c) In relation to Case 2, having recorded a plan on 24 November 2011 to speak to the Service User’s Care Coordinator you:
i) did not contact and/or adequately record contacting the Care Coordinator in a timely manner;
ii) did not inform and/or record informing the Care Coordinator of a potential risk to the Service User, in that a person who answered the phone indicated that he “did not live there” or words to that effect.
d) In relation to Case 8, following information being provided to you during an assessment on 28 November 2011 as to the Service User’s incontinence, you did not make a referral to an incontinence nurse in a timely manner or at all.
3) Did not maintain adequate records in that:
a) In relation to Case 1, in an entry dated 8 November 2011, you:
i) referred to yourself both as ‘therapist’ and as ‘Occupational Therapist’;
ii) made reference to a telephone call but did not state when it occurred;
iii) your entries made on 3 November 2011 and 8 November 2011 were unclear such that they required subsequent amendments.
b) You made amendments to records after entries had been countersigned by your clinical supervisor, in that you:
i) In relation to Case 1, made amendments to an entry dated 17 November 2011;
ii) In relation to Case 5, made amendments to an entry dated 2 November 2011.
c) Did not record the following relevant information:
i) In relation to Case 1, a telephone conversation between you and the Service User which took place on 8 November 2011;
ii) In relation to Case 3, the outcome of the OCAIRs and/or Mayers Lifestyle Questionnaire completed on 25 October 2011 within the case entry;
iii) In relation to Case 8, your entry following the home visit on 25 November 2011 was blank in respect of Objective 3.
d) In relation to case 7:
i) on or around 8 December 2011, did not record sufficient information to identify the level of risk arising from the Service User’s failure to take her medication;
ii) did not seek and/or record seeking advice from a consultant or other suitable professional in relation to the Service User missing her medication.
e) In relation to Case 8, on 25 November 2011 you conducted a home visit and did not conduct and/or record a Mental State Examination (MSE) despite being made aware that the Service User's father had halved his medication the night before your visit.
f) In relation to Case 8, your entry following the home visit on 25 November 2011 did not record sufficient information to enable an assessment to be made of the risk involved after being made aware that the Service User’s father had halved his medication.
4) Did not complete an adequate report in that, in relation to Case 3, the Occupational Therapy Functional Assessment report completed between 11 and 16 November 2011:
a) Contained unnecessary repetition;
b) Recorded information in the wrong sections;
c) Did not include observations on the Service User's abilities and/or functioning during the shopping trip.
5) Did not complete tasks in a timely manner in that:
a) In relation to Case 5, a cooking assessment took place on 1 November 2011 but your report was not completed until 24 November 2011;
b) In relation to Case 3:
i) You had not completed an entry on PARIS for a community assessment made on 2 November 2011 by 9 November 2011;
ii) You had not completed an Intervention Plan by 17 November 2011, despite having been instructed to complete this on 9 November 2011.
c) In relation to Case 7, on 14 December 2011 you had not recorded an assessment and/or completed an intervention plan when the original deadline for completion was 6 December 2011.
d) In relation to Case 8:
i) By 12 December 2011, you had not seen the Service User despite having planned to see him the week of 5 December 2011;
ii) By 12 December 2011, you had not completed an intervention plan when the original deadline for completion was 5 December 2011.
6) The matters set out in paragraphs 1 - 5 constitute misconduct and/or lack of competence.
7) By reason of your misconduct and/or lack of competence your fitness to practise is impaired.

At the substantive hearing the Panel found all of the particulars (above) proved with the exception of 1(c)(i) to (iii). The Panel found the proved particulars amounted to a lack of competence and the Registrant’s fitness to practice to be impaired. A Suspension Order for a period of 12 months was imposed as a Sanction.

Finding

Preliminary Matters
 
1.The Panel was satisfied that appropriate notice of this hearing had been sent to the Registrant at her registered address on 18 March 2019.  The Registrant was present and unrepresented.

2.Ms Whitby requested that the Panel hold parts of the hearing in private should health or private matters arise. The Registrant agreed. The Panel considered the matter.  Bearing in mind the principle of open justice and the HCPTS Practice Note on “Conducting Hearings in Private”, the Panel, having taken advice from the Legal Assessor, determined that any references to private issues that might arise would be heard in private.

Background

3.The Registrant is an Occupational Therapist. She qualified in 1992 and worked for Tees, Esk and Wear Valleys NHS Foundation Trust (the Trust) as an Occupational Therapist from 2001 until 2012.

4.In 2008 concerns arose relating to her ability to perform her job adequately. These concerns persisted throughout 2008 and into 2009. In about November 2009 the Trust received an Occupational Health report, which outlined that the Registrant suffered from a health condition. In light of this health concern, it was decided to redeploy her to a different team. The team to which she was moved was the South Durham Psychosis Team, based at the Goodall Centre. She moved to this team on 1 April 2010.

5.On 27 July 2010, it was reported that there were continuing concerns about the Registrant’s competence, and she was removed from clinical practice on 05 August 2010 and placed within the inpatient Occupational Therapy Team to complete project work not involving patient contact. An investigation was initiated into the Registrant’s clinical practice.

6.In July 2011 the Professional Head of Allied Health Professionals with the Trust, was asked to produce an action plan to support the Registrant’s clinical reasoning, practice, and record-keeping, with a view to returning her to supervised practice. The plan contained 12 objectives. The Registrant was to be based in the Darlington Psychosis Team in October 2011 for three months to receive support and build up her caseload. Other objectives were for her to provide clear evidence of understanding and applying Occupational Therapy processes and to use the Mayers Lifestyle Questionnaire (MLQ) tool and Model of Human Occupational Screening Tool (MOHOST). Her placement was supervised by a Specialist Occupational Therapist and the Registrant was restricted to working on 5 or 6 cases. Any work she did was to be supported by formal weekly supervision, and informal daily supervision.

7.The action plan was formally reviewed in both November and December 2011. On 12 December the Registrant’s placement with the Darlington team was terminated owing to concerns about her practice and service user safety. The concerns were collectively referred to a Disciplinary hearing, which took place on 03 April 2012.

8.The Registrant self-referred the concerns about her practice to the HCPC in June 2012. That referral eventually resulted in these proceedings.

9.The Substantive Hearing took place over a number of days in April 2016 and April 2017. At the outset, the Registrant admitted the following particulars of the Allegation : 1 (f)(i); 2 (b) (i), 2 (b) (ii), 2 (c) (i), 2 (c) (ii), 2 (d), 3 (a)(i), 3 (a)(ii), 3 (a)(iii), 3 (b)(i), 3 (b)(ii), 3 (c)(ii), 3 (c)(iii), 3 (d)(i), 4 (a), 4 (b), 4 (c), 5 (a), 5 (b)(i), 5 (b)(ii), 5 (c), 5 (d)(i) and 5 (d)(ii).

10.The panel at the Substantive Hearing found all the facts proved except for 1(c) (i) - (iii).  It concluded that the Registrant’s fitness to practise was impaired by reason of her lack of competence. That panel’s decision noted the Registrant’s lack of insight and remediation. 

11.At the resumed Substantive Hearing in 2017, the panel decided that the appropriate and proportionate sanction was a 12 month Suspension Order. In imposing the order, and that panel set out that a reviewing panel might be assisted by the following:

•Details of how the Registrant has kept her skills and knowledge up to date during the period that she has not been working as an Occupational Therapist.

•Evidence of the learning the Registrant has acquired.

•Evidence to demonstrate that the Registrant has developed appropriate coping strategies to deal with work related stress that may impact on her health conditions.

12.At the first review of the Suspension Order on 10 April 2018 the reviewing panel decided that the Registrant’s fitness to practise remained impaired and decided to impose a further Suspension Order for 12 months. It noted that whilst some progress had been made, that a risk to service users remained. That panel suggested that the next reviewing panel would be assisted by the following:-

•A testimonial from any OT mentor the Registrant may find to assist her address her shortcomings.

•Details of how the Registrant has kept her skills and knowledge up to date during the period that she has not been working as an Occupational Therapist, including proof of any CPD activity.

•Any further evidence to demonstrate that the Registrant has continued to develop appropriate coping strategies to deal with work related stress that may impact on her health condition.

Submissions for the HCPC

13.Ms Whitby reminded the Panel of its powers of review and its need to assess impairment and, if relevant, to consider sanction.  She reminded the Panel that this was the second review of the 12 month Suspension Order imposed on 19 April 2017 and she reminded the Panel of the background. The Registrant has not worked as an Occupational Therapist for some 8 years and has now completed a course to become a Carer. The Registrant wishes to return to practice as an Occupational Therapist.

14.Ms Whitby submitted that the Panel is required to review the Registrant’s fitness to practise as of today. She submitted that, if it finds the Registrant’s fitness to practise impaired, it may impose the full range of sanctions, including a Striking Off Order at the expiry of the current order by which date the Registrant will have been suspended for two years.


The Registrant’s Evidence and Submissions
 
15.The Registrant took the oath.  She said she had made enquires about courses but had not been able to get on any courses. As regards finding a mentor, the Registrant said this would have cost £500 and she could not afford that. She went on to say that Teesside University did not provide mentoring.

16.As to Occupational Therapist Assistant roles, the Registrant said she was concerned that such a role would prejudice her NHS pension.  She had sought a Carer’s role and had completed a course for Carers last year. She was presently unemployed.  Due to family commitments she had not been able to get an Occupational Therapist Assistant job and she was concerned that such a role was not relevant to the role of an Occupational Therapist. 

17.Ms Whitby asked the Registrant about an Occupational Therapist Assistant role but the Registrant said that she had maintained no contact with other Occupational Therapist’s for some years. As regards courses, she said she had completed a Carer’s course which included studying case studies. The Registrant said she had also explored a return to practise course which had covered general issues such as nursing but had no Occupational Therapist content and was not helpful.  The Registrant said the cost of the courses available was also a concern.

18.The Registrant said that if the Suspension Order were extended she could look at further training course relevant for Occupational Therapists.  She could also look at mental health issues in the Occupational Therapist field. 


Submissions for the HCPC

20.Miss Whitby summarised the HCPC position and submitted that the findings as to competency were in relation to fundamental Occupational Therapist skills.  She submitted that the Registrant’s fitness to practise remains impaired given the lack of remediation and insight.  A risk of repetition therefore remained and that the Registrant remained impaired on both the private and public grounds

21.As to sanction, Miss Whitby submitted that the Registrant had clearly had a difficult year.  A Striking Off Order was available to the Panel but she suggested that a further period of Suspension may be appropriate to allow for more focussed remediation to take place. She submitted nothing less than a Suspension Order would protect the public and the public interest.

The Registrant’s Submissions

22.The Registrant told the Panel that she recognised she did not do a perfect job as an Occupational Therapist but said she felt she could not have done anything else at the time, having failed to get on the MOHT course.  She said that she did not want to leave the profession. She asked that the HCPC give her a clear indication of what she was expected to do if it found her currently impaired.

Decision

23.The Panel accepted the advice of the Legal Assessor. He reminded the Panel that its purpose at review was to conduct a comprehensive appraisal of the Registrant to determine if she is fit to return to unrestricted practice. Its role is not to conduct a rehearing of the allegations or go behind the previous findings. He advised that in carrying out this assessment, the Panel must exercise its own independent judgment.  The Legal Assessor advised that, if it  determined that the Registrant’s fitness to practise remained impaired, it should have regard to the HCPC Indicative Sanctions Policy (ISP) and be mindful of the principles of fairness and proportionality. He reminded the Panel that any sanction it imposes should be the least restrictive order that would suffice to protect the public or is otherwise in the public interest.

24.The Panel considered all the information before it, Ms Whitby’s submissions and the Registrant’s evidence and submissions.  The Panel noted that the Registrant has not worked as an Occupational Therapist since 2012.  The Panel also appreciated and took account of the evidence that the Registrant has faced some personal difficulties over the last year, including financial constraints. It was clear to the Panel that the Registrant, despite attending both previous HCPC hearings, had not been able in advance of the Review Hearing to properly prepare the material she wished to place before the Panel and required significant extra time at the hearing to do so. The Panel considers that this is an example of lack of preparation and focus. 

25.The Panel noted that the Registrant has sought to undertake courses to remediate, and it considered that she is genuinely seeking to remediate her practise.  The Registrant did not peruse the Return to Practise course that she said had identified. Despite the suggestions made by the previous Reviewing panel, the Registrant has not yet addressed the identified issues with her practice such as record keeping and clinical reasoning.  As a result the remediation undertaken by the Registrant in the last 12 months has been very limited, and she has not addressed the particular failings identified.

26.The Registrant demonstrated in her evidence and documentation, limited insight in to her lack of competence.  The Panel found that her insight appears not to have developed since the last review and accordingly concluded that there remains a risk of repetition and a risk of harm to service users.  It decided that the Registrant’s fitness to practise remains currently impaired.  

27.The Panel also determined that, given the risks identified, public confidence would be undermined were it not to find impairment.  A finding of impairment is therefore also required in order to maintain the reputation of, and public confidence in, the profession and the regulator. 

28.The Panel next considered the HCPC Indicative Sanctions Policy.  It was mindful of the need to act proportionately and keep the public interest at the forefront of its mind.  Neither a Caution Order nor a Conditions of Practice Order are appropriate in this case. The findings as to lack of competence are serious and wide ranging and there remains a risk of harm to service users.  There is a lack of evidence of meaningful insight and remediation. The Panel found it was not able to formulate Conditions that would be realistic, workable or proportionate and which would not in effect amount to a Suspension. 

29.The Panel next considered a Suspension Order. The Registrant’s failings are remediable but they have not yet been remedied. The Registrant is genuinely seeking to remediate her practise, but has faced some difficulties in the last year and has made limited progress. The Panel, mindful of the need to protect the public and the public interest, and given the risks identified considered that it was therefore appropriate and proportionate to impose a further period of Suspension.

30.The Panel considered that a further period of 6 months Suspension would be appropriate and proportionate.  It would protect the public, and the public interest, and would provide the Registrant with a further period in which to undertake relevant learning and focus on the remediation of her practise. 

31.A Striking Off Order would not be a fair or proportionate sanction at this time as the Panel have concluded that a Suspension Order was the sufficient and proportionate sanction to protect the public and the wider public interest.

32.A future reviewing Panel would be assisted by the Registrant providing the following :-

•Relevant testimonials  from paid or unpaid work from those who have recent experience of working with the Registrant.

• Details of how the Registrant has kept her knowledge and skills up to date in relation to the specific issues found proved at the Substantive hearing including, for example - record keeping, assessment of service users including safety and clinical reasoning.

•Any further evidence of CPD activity and reflection on that activity particularly how it relates to the competency issue found.

•Any further evidence to demonstrate that the Registrant has appropriate coping strategies in place to deal with return to work related stressors.

Order

That the Registrar is directed Suspend the name of Ruth E. Yorkston from the Register for a period of 6 months on the date this order comes into effect.  

Notes

No notes available

Hearing History

History of Hearings for Miss Ruth E Yorkston

Date Panel Hearing type Outcomes / Status
17/04/2019 Conduct and Competence Committee Review Hearing Suspended
10/04/2018 Conduct and Competence Committee Review Hearing Suspended
18/04/2017 Conduct and Competence Committee Final Hearing Suspended
08/12/2016 Conduct and Competence Committee Final Hearing Hearing has not yet been held
09/11/2015 Conduct and Competence Committee Final Hearing Other