Mrs Sarah E Harrison

Profession: Occupational therapist

Registration Number: OT15752

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 28/02/2019 End: 17:00 28/02/2019

Location: Health and Care Professions Tribunal Service

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

During the course of your employment as an Occupational Therapist at Leicester Partnership Trust, you:

1.In the case of Service User A, between August 2011 - 4 April 2014 or thereabouts, you:

a)Did not document over 40 visits on System 1;

b)Did not conduct and / or document an assessment or intervention regarding the issues identified on the referral to the Community Therapy Service;

c)Did not consistently complete and / or document an assessment into concerns that were raised by Service User A's daughter in relation to:

(i)cognitive capabilities;

(ii)physical capabilities;

(iii)short term memory;

d)When given information about Service User A by his daughter that was of relevance to the Driver and Vehicle Licensing Agency (DVLA), you:

(i)agreed for that information to be withheld from the DVLA;

(ii)did not escalate the above information to his General Practitioner;

2.In the case of Service User B, between June 2013 and December 2013 or thereabouts, you:

a)documented that Service User B was unsafe mobilising and did not carry out follow up visits;

b)documented that Service User B and his wife were unsafe overnight and did not act to address this;

3.In the case of Service User C you discharged and noted "no falls" or words to that effect when the earlier nursing entry confirmed that the patient did have a fall.

4.In an audit of your casework from April 2013 to April 2014 or thereabouts you:

a)Did not consistently document visits that had taken place on System 1 in a timely manner;

b)Did not consistently complete documentation in a timely manner;

c)Did not consistently complete  Occupational  Therapist documentation when joint visits with other health professionals were conducted;

d)Did not consistently complete the discharge process;

e)Did not consistently conduct and / or document initial assessments;

f)Did not consistently conduct holistic assessments;

g)Did not complete and / or document Occupational Therapist kitchen assessments when this was necessary;

h)Did not consistently assess environmental hazards;

i)Did not consistently set goals;

j)When goals were set, did not consistently ensure that these were:

(i)Specific and measurable; and / or

(ii)Occupational Therapist specific;

k)Did not consistently make referrals to healthcare services when this was clinically required and / or indicated, such as:

(i)Physiotherapy;

(ii)The Falls service;

(iii)General Practitioners;

(iv)Neurological service;

(v)Technical Instructors; and/or

(vi)Dieticians;

l)Did not consistently make referrals to the Safeguarding Team and / or Social Services when these were required

m)When ordering equipment for patients, did not consistently:

(i)complete the Occupational Therapist process to ensure the suitability of the equipment;

(ii)document your clinical reasoning for the type of equipment you ordered for patients;

(iii)document follow up visits and / or assessments to check the suitability of the equipment;

n)Acted outside of your profession when you:

(i)carried out the functions of a nurse in relation to the management and administration of medication; and /or

(ii)carried out the functions of a Physiotherapist.

5.The matters set out in paragraphs 1 - 4 constitute misconduct and / or lack of competence.

6.By reason of your misconduct and / or lack of competence your fitness to practise is impaired.

Finding

1.The Registrant is an Occupational Therapist (OT) registered with the HCPC. She was employed as a Band 6 OT by Leicestershire Partnership Trust (the Trust) between August 2011 and April 2014. During the course of her employment, the following concerns came to light in relation to the Registrant’s practice:

•failed to record more than 40 visits to service users;
•failed to conduct and/or record various assessments for service users consistently;
•failed to make consistent referrals to various healthcare services when clinically required and/or indicated;
•failed to provide Service User A’s GP or the DVLA with relevant information.

2. These concerns were referred by the Trust to the HCPC, resulting in these proceedings.

3. A Consent Hearing took place on 31 March 2016. The Registrant did not attend that hearing but had made full admissions to the allegation and to her current impairment. The Registrant consented to the imposition of a Conditions of Practice Order for a period of 2 years. The panel determined that the Registrant had shown insight into the many deficiencies in record-keeping and competency both at the Trust’s Disciplinary Proceedings and by agreeing to the conditions of practice set out in the Order proposed by the HCPC. The panel considered that all matters were capable of being remedied with effort on the part of the Registrant, assisted by processes of regular supervision and auditing.

4. The first review of that Order took place on 21 February 2018. The Registrant attended that hearing and gave evidence. She told the panel that she had been employed in a non-registered capacity unrelated to Occupational Therapy since being dismissed from her employment as an OT in April 2014. However, she wished to return to practise as an OT and intended to undertake a return to practice course. The panel considered that the Registrant had shown little evidence of insight or remediation and found that her fitness to practise remained impaired.  The panel decided that a renewal of the Conditions of Practice Order for a period of 12 months was the appropriate sanction in order to give the Registrant a further opportunity to remediate her shortcomings and return to practice. The panel varied the conditions to practice to the following effect (with changes highlighted in bold):

That the Registrar be directed to annotate the Register to show that for a period of one year from the date that this Order comes into effect (the Operative Date), you, Sarah E Harrison, must comply with the following conditions of practice:

1.You must inform the following parties that your registration is subject to these conditions:

a.any organisation or person employing or contracting with you to provide professional work for which your HCPC registration is required;

b.any agency you are registered with or apply to be registered with for the purposes of the provision of professional services for which your HCPC registration is required (at the time of application);

c.any prospective employer when applying for work for which your HCPC registration is required (at the time of your application).

2.You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

3.You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer, and the outcome of the same.

4.During any period during which you are working as an Occupational Therapist you must place yourself and remain under the supervision of a Registered Health Care Professional, and you must supply details of your supervisor to the HCPC within 28 days of the appointment of that supervisor. You must attend upon that supervisor as required and follow their advice and  recommendations.

5.You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the adequacy and consistency of your record keeping.

6.The Personal Development Plan should be forwarded to the HCPC once complete.

7.You must meet with your supervisor on at least a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan and to review your record keeping practice. You must ensure that there is a written summary of the matters discussed in these monthly meetings that is signed and dated by both yourself and the supervisor and provide these to the HCPC on a quarterly basis.

8.You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9.If you carry out any health or care related work, paid or unpaid, you must prepare a written, reflective account of this and provide these to the HCPC on a quarterly basis.

10.You must arrange for a monthly audit of your record keeping practice to be undertaken by your Supervisor. The audit must be of records made by you personally, include at least three randomly selected sessions in that month, and include all the patients seen at those clinical sessions. The outcome of each audit is to be recorded in writing and should be directed towards assessing the adequacy, standard and timeliness of your record keeping.

11.You must start and maintain a CPD portfolio of activities and learning and send this to the HCPC on a quarterly basis.

Decision
 
5.The Panel today was provided by the HCPC with a bundle of documents including the previous panel decisions and documentation received from the Registrant since the last review hearing.

6.The Registrant provided the Panel with documents, evidencing her continuing professional development since the last review, her voluntary work at a local hospice since January 2019, her records relating to that work and supervision. In addition, the Registrant gave oral evidence to the Panel, confirming her efforts to return to practice and answered questions from the Panel.

7.The Panel first considered whether the Registrant’s fitness to practise is currently impaired.

8.Ms Senior submitted that the Registrant’s fitness to practise remains impaired as she had not yet been able to demonstrate that she has remedied the shortcomings in her record keeping and other failings identified at the original hearing. She submitted that the appropriate sanction on the expiry of the current Conditions of Practice Order would be the renewal of a Conditions of Practice Order with conditions varied to take into account those matters which had already been addressed by the Registrant.

9.The Registrant told the Panel that she was in agreement with Ms Senior’s  submissions.

10.The Panel took into account the HCPTS Practice Notes on “Review of Article 30 Sanction Orders” and “Finding that Fitness to Practice is Impaired”. The Panel accepted the advice of the Legal Assessor.

11.The Panel first considered whether the Registrant’s fitness to practise is currently impaired having regard to the guidance in the case of Abraheem v GMC [2008] EWHC 183 that the reviewing panel’s task is “to consider whether all the concerns raised in the original finding of impairment  … [have] been sufficiently addressed.”

12.The Panel acknowledged that the Registrant had made considerable efforts since the last review to prepare for her intended return to practise as an Occupational Therapist. In particular she has done the following:

•engaged the services of an independent  professional supervisor and informed the HCPC of her supervisor’s identity;
•investigated return to practice courses with the University of Derby;
•undertaken continuing professional development as self-directed study;
•taken on a voluntary role 2 days a week at a local hospice, where she has worked with an Occupational Therapist
•provided written reflections on her experiences within her voluntary role.

13.However, the Panel was not satisfied that the Registrant had yet been able to demonstrate that she had sufficiently addressed the following concerns identified at the original finding of impairment, namely:

•Occupational therapy assessments and goal setting;
•record keeping;
•making appropriate referrals;
•remaining within the scope of her practice;
•management of risk; and
•information sharing with fellow health care professionals.

14.Accordingly, the Panel found that the Registrant’s fitness to practise remains impaired.

15.In considering what, if any, sanction to impose at the expiry of the existing order, the Panel took into account the evidence of the Registrant and the submissions of Ms Senior.

16.The Panel also had regard to the HCPC Indicative Sanctions Guidance and accepted the advice of the Legal Assessor.

17.The Panel considered the available sanctions in ascending order of seriousness and applied the principle of proportionaity.

18.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.

19.The Panel determined that the appropriate and proportionate sanction was to impose a further Conditions of Practice Order for a period of 12 months to give the Registrant a further opportunity to address the outstanding  concerns relating to her practice, whilst ensuring that service users and the public would be adequately protected.

20.The Panel considered that the conditions of practice imposed by the review panel on 21 February 2018 remained largely appropriate, subject to revisions to ensure that that they were more focused and took into the Registrant’s current circumstances.

Order

The Registrar is directed to extend the Conditions of Practice Order, as varied below, against the registration of Mrs Sarah E Harrison for a further period of 12 months on the expiry of the existing Order:


1.You must inform the following parties that your registration is subject to these conditions:

a.any organisation or person employing or contracting with you to provide professional work for which your HCPC registration is required;

b.any agency you are registered with or apply to be registered with for the purposes of the provision of professional services for which your HCPC registration is required (at the time of application);

c.any prospective employer when applying for work for which your HCPC registration is required (at the time of your application).

2.You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

3.You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer, and the outcome of the same.

4.During any period during which you are working as an Occupational Therapist, whether in a paid or unpaid capacity, you must place yourself and remain under the supervision of a Registered Health Care Professional, and you must supply details of your supervisor to the HCPC within 28 days of the appointment of that supervisor. You must attend upon that supervisor as required and follow their advice and recommendations.

5.You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the adequacy and consistency of your record -keeping.

6.The Personal Development Plan should be forwarded to the HCPC once complete.

7.You must meet with your supervisor on at least a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan and to review your practice. You must ensure that there is a written summary of the matters discussed in these monthly meetings and a reflection on your work, whether in a paid or unpaid capacity, that is signed and dated by both yourself and the supervisor and provide these to the HCPC on a quarterly basis.

8.You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

9.You must arrange for a monthly audit of your record keeping practice to be undertaken by your Supervisor. The audit must be of records made by you personally, include at least three randomly selected sessions in that month, and include all the patients seen at those clinical sessions. The outcome of each audit is to be recorded in writing and should be directed towards assessing the adequacy, standard and timeliness of your record keeping.

10.You must maintain a CPD portfolio of activities and learning specifically relating to the deficiencies identified in your practice, namely:


•record keeping;
•making appropriate referrals;
•remaining within the scope of her practice;
•management of risk; and
•information sharing.

and send this to the HCPC on a quarterly basis.

Notes

No notes available

Hearing History

History of Hearings for Mrs Sarah E Harrison

Date Panel Hearing type Outcomes / Status
28/02/2019 Conduct and Competence Committee Review Hearing Conditions of Practice
21/02/2018 Conduct and Competence Committee Review Hearing Conditions of Practice
31/03/2016 Conduct and Competence Committee Final Hearing Conditions of Practice