Ms Ruth Vaughan
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Allegation
During the course of your employment as a Speech and Language Therapist at Bromley Healthcare from around August 2014 until around November 2015, you:
1. In relation to Service User A:
(a) On or around 26 August 2015:
(i) did not choose the most appropriate assessments, in that you assessed Service User A’s spoken word comprehension;
(ii) did not carry out formal assessments in a standardised and appropriate manner in that you failed to assess Service User A’s written word comprehension at a sentence level;
(iii) did not provide Service User A with strategies to assist her word-finding skills after conducting a naming task;
(iv) did not provide all appropriate feedback to the husband of Service User A.
(b) On or around 4 September 2015, did not prepare the discharge report without
significant support from colleagues.
2. In relation to Service User C, or or around 8 September 2015, did not adequately assess whether Service User C was safe for discharge.
3. In relation to Service User D:
(a) On or around 14 September 2015:
(i) did not discuss Service User D’s discharge with your supervisor;
(ii) discharged Service User D when Service User D required further assessment.
4. In relation to Service User E:
(a) On or around 22 July 2015:
(i) did not choose the most appropriate assessments;
(ii) did not carry out a formal reading assessment or a structured informal assessment;
(iii) did not provide adequate feedback to Service User E.
(b) On or around 24 July 2015 you:
(i) did not carry out formal assessments in a standardised and appropriate manner;
(ii) did not adequately justify to Colleague HF clinical decisions relating to Service User E’s care;
(iii) did complete an adequate Cog-Neuro Model Analysis;
(iv) did not provide adequate feedback to Service User E;
(v) did not obtain Service User E’s consent for the activity planned.
5. In relation to Service User F, on or around 28 August 2015, you provided care to Service User F without reading Service User F’s medical notes.
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.
Finding
Preliminary matters
Service of Notice and Proceeding in the Registrant’s Absence
1. The HCPC provided evidence that Notice of today’s hearing had been sent by way of letter on 28 January 2019 to the Registrant’s address on the HCPC register. This contained the full details of the date, time and location of the hearing and the Panel was satisfied that the rules as to service had been complied with.
2. The Legal Assessor advised that the Registrant is resident in Co. Clare, Ireland. In terms of The Health and Social Work Professions Order 2001, rule 22 (7) (c), where the Registrant resides outside the United Kingdom the Panel has jurisdiction to hear this application in England.
3. Ms Dyas applied to proceed in the absence of the Registrant. She submitted that it was appropriate to proceed in absence as the Registrant had clearly indicated in her email on 27 March 2019 that she would not be attending the hearing. It was fair and in the interests of the public to proceed today. An adjournment would serve no purpose.
4. The Panel heard and accepted the advice of the Legal Assessor. He advised that if the Panel is satisfied that all reasonable efforts have been made to notify the Registrant of the hearing then the Panel has the discretion to proceed in the absence of the Registrant. The Legal Assessor referred the Panel to the HCPTS Guidance Note on Proceeding in the Absence of the Registrant and to case of Adeogba v GMC [2016] EWCA Civ 162. The first question the Panel should ask is whether all reasonable efforts have been made to serve the Registrant with notice. Thereafter, if the Panel is satisfied that proper notice has been given, the discretion whether or not to proceed must be exercised with care having regard to all the circumstances of which the Panel is aware with fairness to the Registrant being a prime consideration, but with fairness to the HCPC and the interests of the public also taken into account.
5. The Panel agreed to proceed in the Registrant’s absence as it was satisfied that it is both in the public interest and in the Registrant’s interest to do so. In reaching this decision, the Panel noted that the Registrant had clearly indicated that she would not be attending and she did not seek an adjournment. It balanced fairness to the Registrant with fairness to the HCPC and concluded that the Registrant has voluntarily absented herself and that no useful purpose would be served by adjourning the hearing. The Panel took account of the fact that the Voluntary Removal Agreement (VRA) has been agreed and signed by the Registrant. In these circumstances the Panel is satisfied that it is appropriate to proceed in her absence.
Background
6. The Registrant was employed as a Band 5 Speech and Language Therapist at Bromley Healthcare from 26 August 2014 to 10 November 2015. This was her first clinical post since qualifying. The position was a “rotational” post and initially the Registrant was based in the community. In May 2015 she rotated into the acute service based at the Princess Royal University Hospital (PRUH).
7. At first, the Registrant’s time at PRUH was split between the stroke unit and the rest of the acute wards. However, as of 8 June 2015, the Registrant was placed full time on the stroke unit in order to give her role more stability as concerns had been raised about the Registrant’s performance. The Registrant was sent on a dysphagia course for a week on 22 June 2015. On her return, because of the concerns that had been raised by her previous supervisor, it was decided that the Registrant would be provided with more frequent supervision.
8. On 2 July 2015 the Registrant reported a health issue and it was decided that she should take some time off work. A referral was made to Occupational Health, and she was advised to see her GP. The Registrant returned to work on 20 July 2015 and had a phased return to work until 31 July 2015. Concerns, however, continued to be raised regarding the Registrant’s clinical knowledge and ability to manage a case load independently.
9. On 11 September 2015 the Registrant was informed that she would be placed on an informal capability process. The Registrant requested that her clinical supervisor be changed. On 14 September 2015 SB, a Band 7 Speech and Language Therapist who had previously been providing the Registrant with support and supervision, was formally appointed as the Registrant’s supervisor.
10. On 9 November 2015, the Registrant was invited to a formal capability hearing. The Registrant handed in her letter of resignation the following day and the hearing did not go ahead. The matter was subsequently referred to the HCPC.
11. At a Substantive Hearing before a panel of the HCPC on 30 July 2018 – 1 August 2018 the allegation against the Registrant was fully heard. That panel found all facts proved, except 3(a)(ii), and it concluded that the facts amounted to a lack of competence. It found the Registrant’s fitness to practise was impaired and it imposed a 12 month Suspension Order.
HCPC Submissions
12. Ms Dyas set out the background to the case and asked the Panel to note both the mitigating and aggravating features identified by that panel at the Substantive Hearing.
13. She referred the Panel to the VRA and the HCPTS Practice Note on Disposal of Cases by Consent. She advised the Panel that the Registrant had enquired about voluntary removal and she had ultimately agreed the terms of the VRA now before the Panel. The Registrant, as required, has fully accepted that her fitness to practise is impaired and had signed the VRA. Ms Dyas confirmed that the Registrant had seen and accepted Schedule D of the VRA, although the Registrant had not returned it with her signed agreement.
14. Ms Dyas submitted that in these circumstances, the proposed VRA secured the appropriate level of public protection and would not be detrimental to the wider public interest. She referred to the guidance on Cohen v GMC [2008] EWHC 581 and submitted that the public interest had been satisfied by the consideration of the allegation and the findings of the Substantive Hearing in 2018. She submitted that it was not in the public interest, or in the Registrant’s interest, to keep her on the Register and subject to HCPC orders.
15. She submitted that the VRA was now an appropriate and expeditious way to proceed. The Panel was advised as to what would appear on the HCPC website if a person enquires about the Registrant’s registration.
16. The Panel heard and accepted the advice of the Legal Assessor as to the importance of the public interest and protection of the public. He reminded it of the terms of the VRA and the guidance in the HCPTS Practice Note on Disposal of Cases by Consent as to Voluntary Removal. He advised the Panel that, inadvertently, sub-particular 3(a)(ii) which was found not proved, had been included in Schedule A to the VRA. That was not likely to be material or prejudicial to any party, and in any event could be noted and amended by the Panel in its decision.
Decision
17. The Panel carefully considered the HCPC’s submissions, the HCPTS Practice Note and the VRA. The Panel took account of the fact that the Registrant has fully admitted the allegation and has admitted lack of competence and current impairment.
18. With regard to the issue of protection of the public, the Panel noted that there has been a full, Substantive Hearing of the allegation. It decided that the proposed VRA therefore achieves the appropriate level of public protection by removing the Registrant from the Register. It noted this is the equivalent of a Striking Off Order, the most severe sanction available.
19. The Panel also considered the wider public interest. The Panel noted that the Registrant has agreed to the VRA and has accepted that her fitness to practice is impaired. In November 2015 she told her employer that she no longer wished to pursue a career in Speech and Language Therapy. In these circumstances the Panel is satisfied that the VRA would not undermine public confidence in the profession or the regulator.
20. However, the Panel noted that there is, in error, a reference in Schedule A of the VRA to sub-particular 3(a)(ii) which was found not proved. Whilst the allegation as a whole was found to be well founded that sub-particular was not. This Panel cannot approve a statement that goes behind the final hearing panel and further is not consistent with Schedule D of the VRA. The Panel directs that Schedule A be amended by deleting the reference to sub-particular 3(a)(ii).
21. Further, the Panel determined that paragraph 3.2.3 of the VRA must be read and interpreted in line with the paragraph E and Schedule D of the VRA. Paragraph 3.23 states that the Registrant shall not at any time on or after the Operative Date seek re-admission to the Register. Paragraph E states that the Registrant is to be removed from the Register “as if a Striking Off order had been made”. The Panel noted that if the Registrant had been struck off, she would be entitled to seek re-admission to the register after five years. Schedule D also refers to the VRA being treated in the same way as a Striking Off order should the Registrant ever seek to re-apply to return to the HCPC Register. The Panel determined that the VRA cannot be applied in a manner that is more punitive than the most severe sanction available, Striking Off.
22. In all the circumstances, the Panel determined that the proposed VRA adequately protects the public and the public interest. It is signed and agreed by both the Registrant and the HCPC and appropriately maintains public confidence in the profession and the regulatory process.
23. The Panel agreed to the matter being concluded by means of the VRA and revokes the Suspension Order presently in place.
Order
The Panel directs that the current Suspension Order be revoked and approves the VRA on the basis that the Registrar will remove the name of Ms Ruth Vaughan with immediate effect; it further directs that Schedule A of the VRA be amended with immediate effect by deletion of the reference in the Allegation to sub-particular 3(a)(ii).
Notes
No notes available
Hearing History
History of Hearings for Ms Ruth Vaughan
| Date | Panel | Hearing type | Outcomes / Status |
|---|---|---|---|
| 04/04/2019 | Conduct and Competence Committee | Voluntary Removal Agreement | Voluntary Removal agreed |