Mr Peter D Thorneycroft
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Allegation
As found proven at the final hearing on 12 November 2018:
During the course of your employment as an Occupational Therapist with Birmingham Community NHS Trust:
1. On dates between 02 December 2015 and 23 March 2016, in respect of Patient A you:
a) Did not complete and/or record an initial assessment and treatment plan in a timely manner;
b) Did not complete and/or record an adequate assessment of Patient A’s cognitive and/or physical abilities;
c) Did not coordinate and/or provide Patient A with an intensive rehabilitation programme;
d) Did not complete accurate and/or comprehensive progress notes in that you did not:
i. provide clinical reasoning for doing paper-based activities with Patient A in notes dated 15 December 2015;
ii. complete and/or record an assessment of Patient A’s ability to make drinks and snacks in notes dated 15 January 2016;
iii. 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;
iv. record the content of the tick sheet provided to Patient A on or around 22 January 2016;
v. record adequate information in notes completed on or around 25 January 2016 regarding patient A’s management of washing and/or dressing;
vi. record adequate information of Patient A’s abilities when taken to the shop in notes dated 12 February 2016;
vii. record adequate information about Patient A’s road safety and/or ability to manage money in notes dated 12 February 2016;
e) Did not complete in a timely manner:
i. a laundry assessment;
ii. an adequate lunch assessment.
2. Between 08 January 2016 and 23 February 2016, in relation to Patient B, you:
a) Did not complete an upper limb assessment in a timely manner or at all;
b) found not proved
c) Did not record progress notes in a timely manner in relation to home visits completed on or around:
i. 13 January 2016;
ii. 15 January 2016.
d) Did not complete and/or record a cutlery assessment for Patient B;
e) On or around 01 February 2016, you:
i. took Patient B upstairs without input from a Physiotherapist;
ii. did not conduct a risk assessment and/or identified risks but completed the assessment with Patient B in any event;
f) Did not arrange and/or provide Patient B with sufficient upper limb rehabilitation;
g) On or around 22 February 2016, you took Patient B for a walk outdoors during his therapy session;
i. which was outside your scope of practice;
ii. without a clinical reasoning for doing so;
h) found not proved.
3. Between 15 December 2015 and 24 February 2016, in relation to Patient C you:
a) Did not conduct and/or record an initial assessment for Patient C, in a timely manner;
b) Did not carry out a Wash & Dress assessment for Patient C in a timely manner;
c) Did not conduct a splint session and/or identify the need for a splint for Patient C’s upper limb in a timely manner;
d) Did not arrange and/or provide Patient C with upper limb rehabilitation in a timely manner;
e) 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;
f) Did not conduct sessions and/or record reasons why Patient C missed rehabilitation sessions on dates between 07 January 2016 and 19 January 2016
g) Did not record comprehensive progress notes including:
i. Details of upper limb rehabilitation carried out with Patient C on or around 27 January 2016;
ii. found not proved;
h) found not proved.
i) 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.
4. Between 13 May 2016 and 30 June 2016, in relation to Patient D you:
a) Did not complete a treatment plan for Patient D in a timely manner;
b) Did not complete and/or record an adequate upper limb assessment for Patient D, in a timely manner, or at all;
c) 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.
d) Did not complete comprehensive and/or timely notes including:
i. notes of an initial assessment completed on or around 16 May 2016;
ii. A record of a visit carried out on or around 14 June 2016.
iii. found not proved;
iv. Sufficient clinical reasoning for using Chessington Occupational Therapy Neurological Assessment Battery (COTNAB) on or around 20 17 June and/or 27 June 2016;
e) 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.
f) found not proved.
5. Between 15 February 2016 and 23 February 2016, in relation to Patient E you:
a) Did not complete and/or record a treatment plan;
b) Did not complete an adequate initial assessment on or around 16 February 2016, in that you:
i. did not adequately assess and/or record an adequate assessment of Patient E’s level of cognition;
c) Acted outside your scope of practice in that:
i. On or around 22 February 2016, you made inappropriate recommendations to Patient E’s family regarding his temper;
ii. found not proved.
6. Between 29 March 2016 and 30 June 2016, in relation to Patient F you:
a) Did not complete and/or record an adequate initial assessment of Patient F, in a timely manner;
b) Did not complete an accurate treatment plan in a timely manner;
c) found not proved;
d) Did not complete and/or record a kitchen assessment in a timely manner;
e) found not proved;
f) found not proved.
g) Did not adequately address the patient’s washing and dressing needs in that:
i. found not proved;
ii. found not proved
h) found not proved.
i) found not proved.
7. Between 28 April 2016 and 17 June 2016, in relation to Patient G you:
a) Did not complete an initial assessment in a timely manner;
b)found not proved;
c) You did not carry out and/or record an adequate upper limb assessment;
d) On or around 24 May 2016, you used an inappropriate memory strategy “Sun List” with Patient G.
8. Between 30 March 2016 and 17 June 2016 in respect of Patient H you did not:
a) Complete and/or record an adequate initial assessment and/or upper limb assessment of Patient H, in a timely manner, or at all;
b) found not proved;
c) Did not complete and/record a treatment plan for Patient H in a timely manner;
d) In your notes recorded on or around 13 April 2016, you recorded inappropriate comments “to keep grandchildren alive”;
e) Did not provide and, or any adequate clinical reasoning for:
i. use of COTNAB with Patient H on or around 08, 11 and/or 19 April 2016;
ii. planning to use Rivermead Behavioural Memory Test with Patient H on or around 3 June 2016.
f) found not proved;
g) Inappropriately referred Patient H for a regional driving assessment;
h) Did not appreciate the risk and/or conduct an appropriate risk assessment in relation to Patient H using a lawnmower;
i) Did not appropriately consider rest periods for Patient H between OT sessions;
j) found not proved.
9. Between 01 April 2016 and 28 June 2016, in respect of Patient I you:
a) 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.
b) Did not provide any or any adequate clinical reasoning for using COTNAB.
10. Between 23 October 2015 and 16 February 2016, in respect of Patient J you:
a) Did not complete and/or record an adequate initial assessment and/or treatment plan, in a timely manner;
b) Did not complete and/or record an upper limb assessment of Patient J;
c) found not proved;
d) 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.
e) Did not appreciate the risks associated with playing table tennis with the patient in the ward garden.
11. Between 12 and 28 January 2016, in respect of Patient K you:
a) 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.
12. Your actions described in Paragraphs 1 – 11 constitute misconduct and/or lack of competence.
13. By reason of your misconduct and/or lack of competence, your fitness to practise is impaired.
Finding
Preliminary Matters:
Service of Notice
1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 12 November 2019 sent to the Registrant’s registered address informing him of the date, time, and venue of the hearing.
Proceeding in the absence of the Registrant
2. Ms Simpson made an application for the hearing to proceed in the absence of the Registrant. She referred the Panel to correspondence from the HCPC to the Registrant including her e-mail dated 21 November 2019. There has been no response to any of the HCPC correspondence and the Registrant’s last engagement with the HCPC was in April 2017.
3. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
4. The Panel decided that it was appropriate to proceed with the hearing in the absence of the Registrant. The Registrant has not engaged with the HCPC and the Panel decided that he has waived his right to attend the hearing. There was little prospect that he would attend a hearing at a later date. There was a public interest in the matter being determined expeditiously, particularly as the Suspension Order is due to expire on 17 December 2019.
Background:
5. 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 sixteen years before he resigned in June 2016.
6. The Registrant was rotated into the Birmingham Neuro-Rehabilitation 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.
7. A formal capability process was implemented in April 2016 due to concerns regarding: timely documentation, clinical reasoning, clinical knowledge, planning and prioritisation of occupational therapy goals, and ability to follow the Team’s procedures. The Registrant did not make improvements at Stage 1 of the capability process and the review was escalated to Stage 2 of the formal process. The Registrant resigned in June 2016 and the capability process was not progressed.
8. The HCPC Allegation was considered at a substantive hearing by a panel of the Conduct and Competence Committee on 12-19 November 2018. The Registrant did not attend the hearing or provide written representations. That panel found the facts proved (except 2(b), 2(h), 3(g)(ii), 3(h), 4(d)(iii), 4(f), 5(c)(ii), 6(c), 6(e), 6(f), 6(g)(i), 6(g)(ii), 6(h), 6(i), 7(b), 8(b), 8(f), 8(j), and 10(c).
9. The substantive hearing panel found that particular 8(d), relating to an inappropriate comment in the Registrant’s clinical notes “to keep grandchildren alive”, constituted misconduct. It was highly inappropriate to record a “joke” in a patient’s clinical notes. If it was appropriate to record an expression of humour by the patient himself, 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.
10. The substantive hearing panel found that the remaining proved particulars amounted to a lack of competence. The deficiencies related to the core competencies for an occupational therapist within the overarching themes of timely documentation, clinical reasoning, clinical knowledge, planning and prioritisation of occupational therapy goals, and ability to follow the Team’s procedures. The Registrant’s inability to meet the HCPC Standards of Proficiency for Occupational Therapists consistently, despite considerable support and assistance, demonstrated that his performance was well below the standard expected of a registered practitioner.
11. There was no evidence before the substantive hearing panel that the Registrant appreciated the gravity of his failings, 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 the absence of any insight or evidence of steps the Registrant has taken towards remediation, the substantive hearing panel concluded that there was a real risk of repetition. The Registrant’s persistent inability to make or maintain improvements to his clinical practice put vulnerable patients at risk of harm.
12. The substantive hearing panel also considered the public policy issues including the need to maintain confidence in the profession and declare and uphold proper standards of conduct and behaviour. That panel considered that 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.
13. The substantive hearing panel concluded that the Registrant’s fitness to practise was impaired on the basis of the personal component and the wider public interest.
14. The substantive hearing panel advised the Registrant:
“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 theapy 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.
Decision:
15. Ms Simpson submitted that the Registrant’s fitness to practise remained impaired and that the appropriate order was a Striking-Off Order. She submitted that public confidence in the profession would be undermined by a decision that the Registrant should be given a further opportunity to engage with the HCPC and remediate the deficiencies in his practice in the circumstances of this case. She highlighted the Registrant’s failure to engage with the HCPC since April 2017, his indication at that time that he would not make any representations, and the absence of any response to recent correspondence from the HCPC:
• a letter dated 18 October 2019 reminding the Registrant of the review hearing and the comments by the substantive hearing panel on the evidence which may assist a reviewing panel;
• an e-mail dated 5 November 2019 with a further reminder, setting out the Registrant’s record of no engagement since April 2017, and the HCPC’s position that a Striking-Off order is now appropriate;
• an e-mail dated 21 November 2019 confirming that the HCPC’s position that the panel should impose a Striking Off Order will remain the same at today’s hearing.
16. The Panel accepted the advice of the Legal Assessor.
17. The Panel decided that the Registrant’s fitness to practise remains impaired. There was no evidence that there has been any change in circumstances since the decision of the substantive hearing panel. There was nothing to suggest that the Registrant has remedied the deficiencies in his practice or that he intends to do so. The real risk of repetition therefore remains and this involves a risk of harm to patients.
18. The Panel considered the available sanctions in ascending order of seriousness. The Panel rejected the option of taking no further action or imposing a Caution Order because they would be insufficient to protect the public, given the ongoing risk of harm to patients.
19. The Panel considered a Conditions of Practice Order, but this is not appropriate where the Registrant is not engaging with the HCPC and the Panel can have no confidence in his willingness or ability to comply with conditions. Further, the Registrant was unable to demonstrate sufficient progress when he was subject to the Trust’s formal performance review process.
20. The Panel therefore considered the more serious sanctions of a further period of suspension or a Striking-Off Order. The Panel had in mind that the majority of the particulars involve a lack of competence and only one involves misconduct. This was also a factor that the substantive hearing panel had in mind in its decision to impose a period of suspension, giving the Registrant an opportunity to engage with the HCPC and begin to remedy the deficiencies in his practice.
21. The Panel was of the view that the extent of the Registrant’s failure to engage was significant in this case. He has not engaged with the HCPC for two and a half years and there was no indication that he will address the findings of the substantive hearing panel, or that he wants to or is able to take any remedial action. There was no information suggesting that there are factors preventing the Registrant engaging with the HCPC.
22. The lack of competence found by the final hearing panel was serious, and that Panel identified a real risk of repetition. This had the potential to compromise the safety and well-being of patients.
23. The Panel considered the Registrant’s interests. There was no information before the Panel on the Registrant’s current circumstances or whether he wishes to oppose a striking off order. He was given clear notice of the HCPC’s position that a Striking Off Order was now appropriate and has not responded. In the circumstances, the Panel took the view that the Registrant’s interests were outweighed by the need to protect the public and the wider public interest. In circumstances where a further period of suspension would serve no purpose, the Panel considered that that public confidence in the profession and the regulatory process would be undermined if the Panel did not impose the ultimate sanction.
24. The Panel also considered that the guidance in the HCPC Sanctions Policy for a Striking Off Order applied. In particular a Striking Off Order may be appropriate where the Registrant is unwilling to resolve matters.
25. In all the circumstances, the Panel decided that the sanction of last resort, a Striking Off Order was appropriate and proportionate sanction.
Order
Order: The Registrar is directed to strike the name of Peter Thorneycroft from the register from the date this order takes effect.
Notes
The Order imposed today will apply from 17 December 2019.
Hearing History
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 |