Mr Konrad Sikorski
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During the course of your employment as a Physiotherapist for Western Sussex Foundation Trust;
1. Between approximately 21 October 2014 and 20 July 2015, you;
a) recorded information on patient front sheets;
i) without understanding the implications of recording the information;
ii) without understanding the medical terminology used;
iii) missing significant information that could lead to patient safety being compromised;
b) did not understand the complications and/or safety implications of potential cord compression to physiotherapy treatment, in that you planned to mobilise a patient;
c) inappropriately permitted a patient to continue walking with crutches whilst supervised by Colleague B;
d) did not respond appropriately when a patient’s oxygen levels continued to fall whilst the valve on their CPAP (continuous positive airway pressure) was left open;
e) did not recognise and/or seek assistance when a patient had a vasovagal response;
f) inappropriately permitted a patient to continue walking with a stick whilst supervised by Colleague C;
g) did not adequately communicate with a patient prior to carrying out a stair assessment.
2. The matters set out in paragraph 1 constitute lack of competence.
3. By reason of your lack of competence, your fitness to practise is impaired.
1. The Panel found that there had been good service of the Notice of Hearing by a letter dated 1 February 2019 which informed the Registrant of the date, time and location of the hearing.
Proceeding in the Absence of the Registrant
2. Ms Knight made an application for the hearing to proceed in the absence of the Registrant.
3. The Panel accepted the advice of the Legal Assessor and applied the guidance in the HCPTS Practice Note “Proceeding in the Absence of the Registrant”.
4. The Panel noted that the Registrant did not attend the final hearing or the review hearing on 9 March 2018, and that he has not engaged with the HCPC since the last review. The Panel concluded that his absence is voluntary. He has not requested an adjournment of today’s hearing and the Panel considered that it was unlikely that an adjournment would secure his attendance. Today’s hearing is a mandatory review of a Suspension Order and there is a strong public interest that the hearing should proceed without delay. The Panel decided that the public interest outweighs the Registrant’s interests and that the hearing should proceed in his absence.
5. The Registrant was employed by Western Sussex Hospitals NHS Foundation Trust (‘the Trust’) on 7 May 2014, initially as a Band 3 Physiotherapy Technician. He was appointed as a Band 5 Physiotherapist in July 2014 and placed in a rotational role in order to develop his skills in different aspects of physiotherapy. His duties included the assessment of service users using investigative and analytical skills, the devising of treatment plans, responsibility for the safe use of equipment and to be responsible, as an autonomous practitioner, to undertake an independent clinical caseload.
6. The Registrant’s first rotation session was in the Musculoskeletal Physiotherapy Outpatients Department of Worthing Hospital until 21 October 2014, when he moved to the Respiratory Physiotherapy Team working in the Acute Medical Unit (‘AMU’). In this part of his rotation he was placed under the supervision of DE, a Band 6 Physiotherapist, and his Line Manager was EK, a Band 7 Team Leader for Respiratory Physiotherapy.
7. In the AMU, the Registrant was responsible for the assessment of medical service users, and in particular, elderly service users with respiratory complications. A number of learning objectives were given by DE to the Registrant on 28 October 2014, in view of concerns which had arisen during the first week of his work in the AMU, and as early as the first day of his work there.
8. The concerns included the carrying out of assessments, which first required completion of written ‘patient front sheets’. These are key documents, which set out in summary form the reason why the service user has been admitted to hospital and the significant features of their medical history (including medical conditions and other reasons that may contra-indicate certain physiotherapy techniques). This summary is compiled by the physiotherapist after reading the service user’s medical notes. The front sheet also incorporates an assessment and a proposed plan of treatment. The document would be for use by the physiotherapist treating the service user and other physiotherapists who might treat the service user subsequently. It is a document that will be updated from time to time to reflect any necessary changes.
9. Concerns were picked up within the first two days of the rotation. These included an inability to write accurate front sheets, to extract relevant information from the medical notes and to apply appropriate clinical reasoning to the treatment of service users. In view of the seriousness of those concerns, the Registrant was supervised on a one-to-one basis for the remainder of his time with the Respiratory Physiotherapy Team.
10. In November 2014, because of his difficulties in assessing service users in an acute setting, the Registrant was moved to the medical wards at Worthing Hospital. HC, another Band 6 Physiotherapist, became his supervisor until January 2015, when she rotated to another team. In February 2015, MKS, another Band 6 Physiotherapist, became his supervisor.
11. The Trust took steps to assess the performance of the Registrant under its Capability Policy in view of continuing concerns with the standard of his work. EK created a written Performance Improvement Plan (‘the Plan’) to address the areas of concern, setting standards to be attained with a timescale and an evaluation of progress to date. A supervision review meeting took place on 20 November 2014, at which the Registrant was present. The Plan was updated and further considered by EK with the Registrant on 16 December 2014, at a second supervision review meeting.
12. Formal Capability Review Meetings took place with the Registrant on 13 February 2015, and 16 March 2015. In that period the Plan was further updated and discussions took place between EK and the Registrant with a view to addressing continuing concerns in his practice. A formal letter of concerns, dated 16 April 2015, was sent to the Registrant following a Capability Review Meeting on that day. An informal review meeting took place with the Registrant on 28 May 2015. However, in view of the lack of progress, matters proceeded to a Capability Hearing, which took place on 20 July 2015.
13. A Panel of the Conduct and Competence Committee considered the Allegation against the Registrant at a final hearing which took place from 6-8 March 2017. The Registrant did not attend the final hearing. The Registrant made a full written admission to all the facts of the Allegation and the final hearing panel found the facts proved. The facts found proved related to errors in recording information, inappropriate service user assessments, inadequate treatment plans, and inadequate communication. The final hearing panel found that the standard of the Registrant’s work was unacceptably low by reference to a fair sample of his work. The facts therefore constituted the statutory ground of lack of competence. The final hearing panel noted the absence of evidence of any remedial steps taken by the Registrant or current insight. The panel concluded that the Registrant’s fitness to practise was impaired by reason of the lack of competence.
14. The final hearing panel decided that the minimum sanction which was sufficient to protect the public, to maintain public confidence in the profession and to uphold professional standards was a Suspension Order for a period of 12 months. The final hearing panel stated that a reviewing panel might be assisted by:
• the Registrant’s attendance at the hearing;
• any evidence he might wish to put before the reviewing panel showing steps to bring his knowledge and skills up-to-date and to resolve the deficits in his practice;
• steps taken in advance of the review hearing to attempt to arrange a return to practice placement and the results of such attempts, with evidence of these matters.
15. The Registrant did not attend the first review hearing on 9 March 2018 or provide the panel on that occasion with any relevant information. The panel found that the Registrant’s fitness to practise remained impaired and imposed a further Suspension Order for a period of 12 months on the grounds that it remained necessary for the protection of the public.
16. The HCPC provided the Panel with a bundle of documents containing the previous decisions of the panel and an email dated 20 February 2019, from the HCPC to the Registrant asking him to confirm whether he would attend today’s hearing and advising him that he could attend by telephone or provide written representations for the Panel to consider. However, the Registrant has failed to respond to that email.
17. Ms Knight submitted that, in the absence of any evidence that the Registrant has addressed any of the shortcomings identified in his practice at the substantive hearing, his fitness to practise remains impaired.
18. The Panel took into account the HCPTS Practice Notes on “Review of Article 30 Sanction Orders” and “Finding that Fitness to Practise is Impaired”. The Panel accepted the advice of the Legal Assessor.
19. 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  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”.
20. The panel at the final hearing identified a broad range of deficiencies in the Registrant’s practice involving the basic skills and knowledge of a physiotherapist. There were serious and persistent concerns relating to the Registrant’s practice over a long period of time. There was no evidence that the Registrant had the ability to work as an autonomous practitioner. The identified deficiencies involve the risk of significant harm to service users and to the wider public who may use the Registrant’s services. Although the deficiencies are remediable, there was no evidence that they had been remedied.
21. The Panel today noted that the Registrant had provided no evidence of having gained any insight or attempted any remediation of the deficiencies in his practice since the final hearing. Notwithstanding having been given guidance by both the final hearing panel and the previous reviewing panel as to what evidence might assist future panels. The Panel therefore concluded that the Registrant’s fitness to practise is currently impaired.
22. In considering what, if any, sanction to impose at the expiry of the existing Order, the Panel took into account the HCPC “Indicative Sanctions Policy” and accepted the advice of the Legal Assessor.
23. The Panel considered the available sanctions in ascending order of seriousness and applied the principle of proportionality.
24. The Panel considered the option of allowing the current Suspension Order to expire, but decided it remains necessary for the Registrant’s practice to be restricted to protect the public. For the same reason a Caution Order would not be sufficient.
25. The Panel next considered whether the Suspension Order could be replaced by a Conditions of Practice Order. The Panel decided that it was not possible to formulate conditions of practice which would adequately protect the public, while not being so restrictive that they amounted to a Suspension Order. Further, there was no evidence to persuade the Panel that conditions would be effective. When employed by the Trust the Registrant was subject to a nine month period of supervision and support, but he still failed to meet the required standards.
26. The Panel therefore decided that the appropriate Order is to extend the current Suspension Order. The Panel decided that this should be for a period of 12 months. This will give the Registrant time to reach a mature decision as to whether he wishes to take the necessary steps to remediate his deficiencies in practice with a view to returning to practise as a Physiotherapist. The Registrant should be in no doubt that, if he fails to use this time to address the failures in his practice, the option of a Striking Off Order will be available to the next reviewing panel.
27. Before the suspension expires the Registrant’s case will be reviewed by another panel at a further hearing. A future reviewing panel may be assisted by;
• the Registrant’s attendance;
• any evidence he may wish to put before the reviewing panel showing steps he has taken to resolve the deficits in his practice;
• any evidence he may wish to put before the reviewing panel showing steps he has taken to keep his knowledge and skills up to date;
• any steps he has taken to attempt to arrange a return to practice placement and the results of such attempts, with evidence.
The Registrar is directed to suspend the registration of Mr Konrad Sikorski for a further period of 12 months on the expiry of the existing Order.
The Order imposed today will apply from 5 April 2019.
This Order will be reviewed again before its expiry on 5 April 2020.