Miss Deborah J Watson
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Whilst registered as an Occupational Therapist you:
1. On 16 July 2015:
a) In relation to Service User A:
i) Left her in the therapy suite unaccompanied; and/or
ii) Did not review the observation and engagement care plan for Service User A; and/or
iii) Did not enquire as to what observation levels Service User A was on.
b) In relation to Service User B:
i) Allowed him to leave the therapy suite without escort; and/or
ii) Did not check the observation and escort requirements of Service User B with ward staff; and/or
iii) Did not follow the observation and escort requirements of Service User B.
c) In relation to Service User C:
i) Did not check the observation and escort requirements of Service User C with ward staff; and/or
ii) Did not follow the observation and escort requirements of Service User C.
2. Between April 2014 and October 2014 did not seek clinical supervision.
3. On 19 November 2014, in respect of a GP referral of Service User E did not:
a) Follow up the referral; and/or
b) Prepare a risk assessment; and/or
c) Prepare a risk management plan.
4. The Matters set out 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 Panel received a hearing bundle of 46 pages from the HCPC, and a bundle of 42 pages and a small bundle of email correspondence of 9 pages from the Registrant.
2. The Registrant is an Occupational Therapist registered with the HCPC. During the period referred to in the Allegation, she was employed as a Band 6 Care Co-Ordinator Occupational Therapist by Leeds and York Partnership NHS Foundation Trust. From 1 October 2016, the Registrant was employed by Tees, Esk and Wear Valleys NHS Trust (“the Trust”) in a community setting.
3. Concerns arose in respect of the Registrant’s practice and a Performance Improvement Plan was implemented. The Registrant was moved to a role in a mental health ward, where she was subject to supervision. A further concern arose when the Registrant left a service user unaccompanied in a therapy suite. An investigation was undertaken, as a result of which further concerns about the Registrant’s practice were identified.
4. The Registrant referred herself to the HCPC on 20 October 2015. The Trust conducted a disciplinary hearing in March 2016 which resulted in the Registrant’s dismissal for gross misconduct.
5. The substantive HCPC Conduct and Competence Committee hearing took place on 11-13 December 2017. The Panel at that hearing found all the factual particulars of the Allegation proved and that the facts amounted to misconduct. The Panel found the Registrant’s fitness to practise impaired in relation to both the personal and public components of current impairment. The Panel determined to impose a Suspension Order for a period of 12 months.
Review hearing 7 December 2018
6. The Suspension Order was reviewed by a panel of the Conduct and Competence Committee at a hearing, which the Registrant attended and at which she was represented, on 7 December 2018. The panel considered the guidance given by the substantive hearing panel as to information which a future review panel was likely to find helpful.
7. The Registrant presented information about actions she had taken since the Suspension Order was imposed. The first review panel considered information presented by the Registrant and heard oral evidence from her. She said she did not feel confident to return to her role and herself considered that her fitness to practise remained impaired.
8. The first review panel stated that it was impressed by the Registrant’s reflective statements and the development of her insight into the effect and consequences of her past failures in care. However, the review panel stated that it was not satisfied that the Registrant had demonstrated that she had applied her knowledge of theory to the specific failings identified at the substantive hearing. She admitted that there remained gaps in her knowledge and skills. In the view of the review panel, these gave rise to a risk of repetition which could potentially pose a risk to service users and undermine public confidence in the profession.
9. The Panel found that the Registrant’s fitness to practise remained impaired and determined to extend the Suspension Order for a further 12 months. This would allow the Registrant to demonstrate at the next review hearing that she had made sufficient progress in her professional development to return to practice as an Occupational Therapist.
Submissions of the HCPC
10. Ms Ktisti reminded the Panel of the history of the Registrant’s case and said the HCPC’s position was neutral as to the appropriate outcome today. She reminded the Panel that at an Article 30(1) review hearing the persuasive burden is upon the Registrant to satisfy the Panel that she is fit to return to practice.
Submissions of the Registrant
11. Mr Oestreicher, on behalf of the Registrant, told the Panel that the Registrant accepted that her fitness to practise remained currently impaired.
12. The Registrant’s bundle included documents relating to remediation she had undertaken since the first review hearing and included:
• A reflective statement dated December 2019;
• A health report;
• References and correspondence;
• Return to Practice plan;
• A job description for a CAMHS Activities Facilitator;
• A Curriculum Vitae.
13. The Registrant gave evidence to the Panel. She told the Panel she believed that her fitness to practise remains currently impaired.
14. The Registrant informed the Panel that the voluntary post she had held had been helpful and had been an opportunity to “test the water” and to gain some experience of risk-related issues. However, she told the Panel that she felt she did need the opportunity to practise again in a professional environment and to undertake further study, and to work with a supervisor and receive their feedback. The Registrant said that she planned to apply for a voluntary placement role in a Child and Adolescent Mental Health Service unit where she had previous applied for an OT Assistant position. In this voluntary role she would be supervised, and the Registrant said that she planned to undertake this alongside further study and reflection. In answer to Panel questions, the Registrant confirmed that she has not made any application for such a role as yet. She said she was fortunate to have found an experienced ex-Occupational Therapist, MD, who was willing to assist her in undertaking further study. She planned to meet with MD to discuss this further. The Registrant said that she was now feeling more positive about her plans.
15. When asked by the Panel why she believed her fitness to practise remained impaired, the Registrant indicated there was an issue of confidence, but also that she needed to undertake study to fill gaps in her knowledge. She thought these knowledge gaps had been present during her time in practice but that she may not have been aware of them. The areas where the Registrant believed she needed to improve her knowledge were set out in her reflective statement. When asked about her anticipated timeframe, the Registrant suggested that her further development may take six months.
16. During the Panel’s questions for the Registrant, the Panel, with the consent of both parties and having taken legal advice, went into private session to ask some questions.
17. In closing submissions, Mr Oestreicher said that whilst the Registrant accepted that her fitness to practise remained impaired and he acknowledged that the Panel may decide that suspension continued to be necessary, he would ask the Panel to consider whether conditions of practice could be formulated which would allow her to work as an Occupational Therapist. He submitted that in the light of her past engagement with the HCPC process, the Registrant could be trusted to comply. Being permitted to practise would allow her to obtain a role where she could develop her skills in practice and also ensure that she could access a Return to Practice course, for which he said HCPC registration is required.
18. The Panel took into account the submissions of the parties and accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Notes “Finding That Fitness to Practise is ‘Impaired’” and “Reviews of Article 30 Sanction Orders”, and to the HCPC Sanctions Policy.
19. The Legal Assessor reminded the Panel that it should first consider whether the Registrant’s fitness to practise remains currently impaired. She reminded the Panel of its powers at a mandatory review under Article 30(1) of the Health Professions Order if current impairment is found, and that it should impose the least restrictive order which appropriately protects the public and the public interest.
20. The Panel carefully considered the information presented by the Registrant, which included a detailed reflective statement. The Panel acknowledged the work the Registrant had undertaken and that she had made some progress.
21. The Registrant told the Panel that she believed her fitness to practise is currently impaired. The Panel considered that the Registrant’s past failures in practice were capable of remediation. Her reflection showed that she had continued to develop insight into her past failings and the Panel noted that in her reflective statement, the Registrant refers to an occasion when working (in a voluntary role) with a young person when she was able to identify risk and take appropriate action. However, the Registrant told the Panel that she believes there are gaps in her skills and knowledge which she believes she needs to address before she can recommence unrestricted practice. She told the Panel the gaps related to basic skills and knowledge. She did not envisage being ready to return to practice for at least six months or so. The Panel asked the Registrant about returning to supported and restricted practice and she maintained that she was not yet ready to do this.
22. Having heard the Registrant’s evidence, the Panel was of the view that there remains a risk to the public as a result of the areas in which she needs to develop and improve her knowledge and skills, as set out in her reflective statement:
“Reflective Practice and reflective tools
Risk/risk management planning
Principles of assessment
Learning skills and techniques
Models of practice
Further study/ practice in:
Review and appraisal of research
23. The Panel observed that although the Registrant has described a plan for her further remediation and to address her knowledge gaps, there has been little positive progress towards actioning this plan and the Panel had a residual concern about the Registrant’s commitment to do so.
24. The Panel found the Registrant’s fitness to practise to be currently impaired in respect of the personal component.
25. The Panel also found impairment in respect of the public component. It concluded that members of the public would be concerned if the Registrant, who has admitted gaps in her basic skills and knowledge which pose a potential risk to the public, and who accepts that she remains impaired, were found not be to impaired. Public confidence in the profession and the regulatory process would be undermined. The Panel therefore concluded that the Registrant’s fitness to practise is also currently impaired on the grounds of public protection and the wider public interest.
26. The Panel considered the available sanctions and referred to the HCPC Sanctions Policy. It applied the principle of proportionality and carefully considered the sanctions in ascending order of seriousness.
27. The Panel considered that it would not be appropriate to impose no order or a Caution Order because the public would not thereby be protected and the wider public interest would not be adequately addressed.
28. The Panel took into account Mr Oestreicher’s submission relating to conditions and therefore carefully considered whether it could formulate a Conditions of Practice Order. However, the Panel concluded that a Conditions of Practice Order would not be appropriate or workable as the Registrant has acknowledged basic failings in her knowledge and skills which may have been present at an earlier stage, but of which she may not have been aware. The Panel considered that conditions would not be workable or appropriate until these fundamental gaps in her knowledge have been addressed, because these gaps may give rise to risk.
29. The Panel concluded that a further period of suspension of 12 months would be appropriate and proportionate to address public protection and the wider public interest issues. The Panel considered that a shorter period would not realistically allow the Registrant sufficient time to complete the programme she has described to the Panel. The Panel noted there is an option for her to apply for an early review of the suspension under Article 30(2).
30. The Panel acknowledges that the Registrant believes she now has a plan in place which she will put into action in the New Year and encourages her to actively initiate and follow this plan.
31. Whilst this Panel cannot bind any future reviewing panel, such a panel is likely to be assisted by:
• The Registrant’s attendance at the review hearing;
• Evidence that she had undertaken training to address gaps in her knowledge and skills;
• Evidence of the Registrant’s work since the first review hearing, whether paid or unpaid, in a role related to that in which her knowledge and skills as an Occupational Therapist have been deployed, together with any references or testimonials in relation to such work - especially in relation to her ability to assess and respond to risk;
• Evidence of her Continuing Professional Development (“CPD”) and that she has kept her knowledge of Occupational Therapy up-to-date.
The Registrar is directed to suspend the registration of Miss Deborah J Watson for a further period of 12 months upon expiry of the existing Order.
The Order imposed today will apply from 13 January 2020.