Ms Leila Annikici Karhu
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Whilst registered as a Social Worker and during the course of your employment at Wolverhampton City Council,
1. On or around the 01 October 2016, in relation to Child A's safeguarding referral,
a. you did not:
(i) Contact Child A's father to obtain further information
(ii) Contact medical professionals to assess the gravity of Child A's injuries
(iii) Contact Child A's mother to agree a formal safeguarding plan
(iv) Hold a strategy discussion with the police
(v) Undertake background checks on Child A and/or Child A's family from Wolverhampton City Council's records
(vi) Visit Child A
b. You did not provide Colleague A with handover information about the safeguarding referral about Child A.
2. You did not complete and/or record 24 AMHP assessments in a timely manner.
3. The matters set out in paragraphs 1 - 2 constitute misconduct and/or lack of competence.
4. By reason of your misconduct and/or lack of competence your fitness to practise is impaired.
1. The Panel was satisfied that the Registrant had been served with notice of the hearing in accordance with Rules 3 and 6 of the Health and Care Professions Council (Conduct and Competence Committee)(Procedure) Rules 2003.
2. Mr Dite made an application for the Panel to proceed with the hearing in the absence of the Registrant pursuant to Rule 11. The Panel was informed that the Registrant had not engaged with the HCPC in these proceedings since October 2018. She had then applied for and was granted an adjournment on medical grounds of the substantive hearing of this case listed on 22 October 2018. She had not responded to any of the subsequent communications sent by the HCPC to her current address on the register and to the email address she had provided. She had not applied for an adjournment or provided any information as to why the hearing should be adjourned.
3. The Panel took into account the HCPTS Practice Note on Proceeding in the Absence of a Registrant and accepted the advice of the Legal Assessor. The Panel was satisfied that the Registrant had voluntarily absented herself from the hearing and waived her right to attend. Given the previous history of non-engagement, the Panel considered that an adjournment of today’s hearing would be unlikely to secure the Registrant’s attendance at a future date. As the case concerns public protection issues, the Panel considered it should be heard without undue delay. The Panel also had to consider the convenience of witnesses who had attended to give evidence. In all the circumstances, the Panel decided that it should proceed with the hearing in the absence of the Registrant.
4. The Panel granted Mr Dite’s application for any evidence relating to the Registrant’s private life to be heard in private.
5. The Registrant is registered with the HCPC as a Social Worker. She was employed as a Social Worker by City of Wolverhampton Council (the Council) for some 25 years prior to the matters to which this case relates. The Registrant’s substantive daytime post was in the Older People Service. She also worked as a sessional worker for the Emergency Duty Team (EDT) every Saturday night. She had worked for the EDT for 11 years. She had also recently qualified as an Approved Mental Health Practitioner (AMHP) and was on occasions required to exercise that role both as a member of the EDT and in her substantive daytime post.
6. On Saturday 1 October 2016, the Registrant was working a 12-hour shift on EDT between 9:00 pm and 9:00 am the following day. A Child Protection incident was referred to EDT at 21:15 on 1 October 2016 in relation to a child who had been bitten by a dog. The child’s family was subject to a Child in Need plan at the material time.
7. It is alleged that the Registrant did not take the appropriate action upon receiving the referral in various respects as set out in particulars 1a(i)-(vi) of the allegation. It is further alleged that she did not provide any handover to the Social Worker who took over the shift at 9:00 am the following morning as set out in particular 1b.
8. These concerns were looked into by the Registrant’s EDT line manager NM, who was employed by the Council as a Senior Social Work Manager in the EDT. She was informed of these concerns on Monday 3 October 2016 and discussed them with the Registrant at a meeting on 6 October 2016.
9. At about the same time, other concerns came to light about the Registrant’s alleged failure to complete and/or to record on the Council’s electronic recording system a number of AMHP assessments. This was looked into by MK, who was employed at the time as the AMPH Lead for the Council.
10. The concerns relating to the Registrant’s handling of the child protection incident on 1-2 October 2016 and her alleged failure to complete and/or record AMPH assessments were subject to a formal investigation by JE, who was employed as an Independent Investigating Officer by the Council.
11. The investigation led to a disciplinary hearing. However, in July 2016 the Registrant had already been discussing resignation with her line manager and before the disciplinary hearing, she had resigned from her employment with the Council.
12. The Council reported its concerns about the Registrant’s practice to the HCPC, resulting in the current proceedings.
The evidence in the case
13. The HCPC provided the Panel with a bundle of documents, including the statements and exhibits of the three witnesses referred to above (NM, MK and JE).
14. The Registrant had been served with the HCPC bundle, including the witness statements, prior to the hearing but did not provide the Panel with any comments on the evidence or with any statement of her own.
15. The first witness to give evidence was MK. The Panel found him to be a credible and reliable witness who gave his evidence clearly and in a straightforward manner. He readily acknowledged the limits to his recollection of matters about which he was questioned. He provided the Panel with useful contextual evidence; and, in relation to particular 1b, helped the Panel to understand the distinction to be drawn between completing assessments and recording them electronically.
16. NM gave her evidence remotely by telephone. She provided the Panel with her understanding of the Registrant’s difficult personal circumstances and an overall view of the Registrant’s performance at work, about which she was extremely positive.
17. JE also gave evidence by telephone and confirmed the contents of her statement and the substance of her interview with the Registrant and others concerned in relation to her investigation. The Panel found her to be a credible witness. However, her evidence was limited to the content of her statement and she fairly admitted that she had little recollection outside her statement. She was unable to give direct evidence in relation to the allegation and her evidence was therefore of limited value.
Burden and standard of proof
18. The Panel was mindful that the burden of proof was on the HCPC and that the civil standard of proof applied, so the particulars of the allegation must be proved on the balance of probabilities.
19. The Panel took into account submissions by Mr Dite on behalf of the HCPC and accepted the advice of the Legal Assessor.
The Panel’s findings of fact
20. Overall, the Panel found particulars 1(a)(i)-(vi) and 1(b) proved on the evidence of NM and JE’s interview with the Registrant.
21. The Panel accepted NM’s evidence as follows:
• NM described the Registrant as extremely hardworking, reliable and very honest. NM had never previously known the Registrant not to follow up on calls to EDT and there had been no previous concerns about her work in EDT. She was a very valued member of staff;
• around the time of the incident in question, NM understood that the Registrant was going through a very difficult time in her private life; her health had been adversely affected and she had been struggling to cope with the pressures of her daytime role at work;
• on 1 October 2016 the Registrant was working as a lone Social Worker in EDT on a 12-hour shift from 9:00 pm until 9:00 am the following day;
• at 9:15 pm on 1 October 2016 the Registrant received a call regarding Child A, who had been bitten by a dog. Child A had been taken to hospital and the incident reported to the police;
• the family of the child were known to Social Services in relation to child protection issues;
• NM told the Panel that the Registrant did not follow up the referral call sufficiently robustly in accordance with established procedures and patient measures in place to safeguard Child A as detailed in particulars 1a(i)-(vi) of the allegation;
• neither did the Registrant provide a handover to the incoming shift, nor detail any information about the referral in the EDT shift handover book.
22. JE gave evidence that, as part of her investigation, she questioned the Registrant about her activities in relation to this incident. JE told the Panel that she was no longer able to recall the details of her investigation, but relied upon her statement and investigation meeting notes and records. However, she did recall that the Registrant during the interview was extremely upset and remorseful.
23. The Panel accepted JE’s evidence as recorded in her meeting notes as follows:
• the Registrant had admitted not dealing with the referral appropriately;
• the Registrant’s daytime workload had become too excessive and she felt that she was not coping with it;
• the Registrant was not feeling well on 1 October 2016; and had flu-like symptoms for which she was taking medication. This was the first time she had felt insufficiently fit to go to work;
• the Registrant stated that, other than trying to contact Child A’s father, she did not take any other substantive action on the referral;
• the Registrant did not provide any handover to the incoming EDT shift.
24. With regard to particular 1a(i), the Panel noted that the Registrant had attempted to contact the father of the child by making a telephone call to the mobile telephone number she had been given. However, she had been unable to contact the father shortly after receiving the referral. Particular 1a(i) is therefore proved.
25. With regard to particular 1a(ii), when interviewed by JE on 25 October 2016, the Registrant stated that she had waited to hear from the hospital, which had a duty to notify EDT with information about children who had been treated for suspected non-accidental injuries. However, she admitted that she had not telephoned the hospital herself. Particular 1a(ii) is therefore proved.
26. Particulars 1a(iii), (iv), (v) and (vi) are proved on the basis that the Registrant admitted to JE and NM that she had taken no other steps in relation to the incident apart from her attempt to contact the father by telephone. The Panel also noted the absence of any record that the Registrant had taken any steps by way of investigation or safeguarding.
27. With regard to particular 1b, the Registrant admitted to NM and JE that she had not provided Colleague A with handover information about the safeguarding referral in relation to Child A. This was confirmed to NM by Colleague A. NM also gave evidence that she had checked the handover book, which contained no reference to the incident or any step taken by the Registrant in relation to thereto. Particular 1b is therefore proved.
28. The evidence in support of particular 2 was provided by MK, whose witness statement was to the following effect:
• AMHP assessments are required when a person is detained under the Mental Health Act 2005
• They are required by the hospital which is receiving a patient, along with a medical recommendation and application. The AMHP assessment details the reason why it is believed that a person needs to be detained
• A copy of the AMHP assessment is given to the hospital, a copy is put in the patient’s medical records and a copy goes to the GP
• EDT had a simplified AMHP report, which could be handwritten if there were issues with access to the electronic database during the night and weekends. The report would then be inputted the following day. The electronic record should ideally be made within 24 hours, or at the latest within 7 days, of the assessment
• During September 2016 it came to MK’s attention that an AMHP assessment of a service user appeared to have been started but not completed by the Registrant. MK contacted the Registrant about this on 20 September 2016 and asked her to complete it as soon as possible
• On 30 September 2016 MK noticed that the assessment in question had still not been completed. He again contacted the Registrant and asked her to complete the assessment
• MK asked the IT department to send him a list of AMHP reports allocated to the Registrant that had not been entered as completed into the Care First electronic recording system. They sent him a list of 24 names of service users over a 12 month period, where assessments were “incomplete”. These incomplete assessments were a mixture of some that had been allocated but not generated and others generated but not completed. He stated that he had looked at some of the listed assessments and recalled that a number had contained some information, whilst others had no information.
• MK questioned the Registrant about these matters on 6 October 2016 to ask if there were reasons why she had been unable to complete the assessments and to arrange a plan for them to be completed. He stated that the Registrant advised that this was down to personal difficulties she was experiencing
• MK produced a computer-generated record of 24 assessments which he said had been initiated by the Registrant but not completed.
29. When questioned by the Panel about his statement, MK drew a distinction between the Registrant completing the assessments of service users, on the one hand, and recording those assessments on the Council’s electronic system on the other. He said that he accepted that the Registrant had carried out the assessments in question and had handwritten notes to that effect. However, he stated that she had not completed a record of these assessments electronically.
30. However, the Panel was not provided with any of the electronic records in question and MK was unable to recall how many he had checked or any specific details relating to any record out of the 24 listed. He was therefore unable to give any example of any particular assessment that had not been recorded by the Registrant in a timely manner. The Panel was not provided with any documentation in relation to any of the particular service users from which it could have ascertained what information should have been recorded by the Registrant or when it should have been recorded. The Panel concluded that the evidence adduced by the HCPC was inadequate and insufficient to establish particular 2 to the required standard. Accordingly, the Panel found particular 2 not proved.
31. The Panel went on to consider whether the facts found proved, or any of them, amounted to misconduct and/or lack of competence, as alleged in particular 4. The Panel took into account the submissions of Mr Dite and accepted the advice of the Legal Assessor.
32. The Panel was mindful that the question whether the proven facts constituted misconduct or lack of competence are matters for the Panel’s professional judgement, there being no standard or burden of proof.
33. The Panel took note of the guidance that lack of competence is different to negligence and misconduct. As stated in the case of Calhaem v GMC  EWHC 2606 (Admin), it “connotes a standard of professional performance which is unacceptably low and which (save in exceptional circumstances) has been demonstrated by reference to a fair sample of the [registrant’s] work”.
34. The Panel took into account that the proven facts related to a single isolated incident on the part of a Registrant, who was described by NM as experienced, hardworking and reliable. The Registrant’s failures in this incident did not therefore relate to a fair sample of her work. In the circumstances, the Panel did not consider that the facts constituted lack of competence.
35. The Panel went on to consider whether the proven facts constituted misconduct.
36. The Panel took into account that misconduct was defined by Lord Clyde in Roylance v General Medical Council (no 2)  1 AC 311 as :
“a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances”.
37. It is clear from case law that misconduct must be sufficiently serious in order to be judged as misconduct in fitness to practise.
38. The Panel found that the Registrant’s failure to take sufficient steps to investigate the reported incident and to put in place measures to protect Child A were very serious and had the potential to put Child A at risk of harm. The Registrant has provided no explanation as to why she failed to take any appropriate steps or what she had done on the shift, which was described by NM as having been relatively quiet. If, as the Registrant later suggested, she was too unwell or otherwise unfit to work on that shift, then, as a professional social worker, she should have ensured someone else was called in to take over and, at the very least, she should have properly handed over the case to her colleague at the end of the shift. NM told the Panel that she was very concerned about the actions that were not taken and she said that it raised significant concerns.
39. The Panel found that the Registrant by her omissions was in breach of the following standards of the HCPC Standards of Proficiency for Social Workers (the 2012:
• Standard 1.3 (be able to undertake assessments of risk, need and capacity and respond appropriately);
• Standard 1.4 (be able to recognise and respond appropriately to unexpected situations and manage uncertainty)
• Standard 1.5 (be able to recognise signs of harm, abuse and neglect and know how to respond appropriately)
• Standard 4 (be able to practise as an autonomous professional, exercising their own professional judgement).
40. The Panel also found the Registrant by her omissions to have been in breach of the following standards of HCPC Standards of Conduct, Performance and Ethics (2016):
• Standard 2 (Communicate appropriately and effectively);
• Standard 6.1 (You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible);
• Standard 6.3 (You must make changes to how you practise, or stop practising, if your physical or mental health may affect your performance or judgement, or put others at risk for any other reason); and
• Standard 7 (Report concerns about safety).
41. In all the circumstances, the Panel found that the proven facts constituted misconduct.
Decision on Impairment
42. The Panel took into account the submissions of Mr Dite. The Panel had regard to the HCPTS Practice Note on Finding that Fitness to Practise is Impaired and accepted the advice of the Legal Assessor.
43. In determining whether the Registrant’s fitness to practise is currently impaired by reason of her misconduct, the Panel took into account both the “personal” and “public” components of impairment. The “personal” component relates to the Registrant’s own practice as a Social Worker, including any evidence of insight and remorse and efforts towards remediation. The “public” component includes the need to protect service users, declare and uphold proper standards of behaviour and maintain public confidence in the profession and the Regulator.
44. With regard to the “personal” component of impairment, the Panel acknowledged that the Registrant had shown remorse for her failings in relation to the relevant incident. However, the Registrant had provided no adequate explanation either contemporaneously or subsequently as to reasons for her failures. She had provided no evidence of any steps taken to remediate her failures. Nor had she provided any information to reassure the Panel that any factors relating to her health or private life which may have contributed to her failures had since been resolved, so that they would no longer have a negative impact on her ability to practise safely. In the circumstances, the Panel considered that there was a risk of repetition. The Panel determined that the Registrant’s fitness to practise remains impaired in relation to the “personal” component.
45. The Panel also found the “public” component of impairment to be satisfied in this case. A member of the public with knowledge of the Registrant’s failure to take any effective steps to safeguard a vulnerable child in such circumstances would be extremely concerned to learn that the Regulator had failed to place any restriction on her registration. The Registrant’s misconduct posed a risk to service users, as a result of which public confidence in the profession and in the regulator would be undermined if there were no finding of impairment.
46. Accordingly, the Panel found that the Registrant’s fitness to practise is currently impaired by reason of her misconduct.
Decision on Sanction
47. The Panel took into account the submissions of Mr Dite.
48. The Panel adopted the HCPC Indicative Sanctions Policy and accepted the advice of the Legal Assessor. The Panel was mindful that the purpose of a sanction is not to punish the Registrant but to protect the public and the wider public interest of upholding proper standards and maintaining public confidence in the profession and the Regulator. The Panel applied the principle of proportionality, balancing the interests of the Registrant with those of the public, and considered the available sanctions in ascending order.
49. The Panel considered both the aggravating and mitigating factors in the case.
50. The aggravating features were the Registrant’s failures to respond appropriately to the EDT which could have placed a vulnerable child at risk of harm and her failure to provide any explanation.
51. The mitigating features are that:
• prior to this incident, the Registrant had a long and unblemished career as a Social Worker. She was described by NM, her EDT line manager, as hardworking, honest, and a reliable and a valued member of the EDT, who had never previously failed to follow up a call to EDT;
• the case relates to a single, isolated incident, which appears to have been an aberration in an otherwise exemplary career;
• there appear to have been particular factors in the Registrant’s private life and health, and additional work-related stress, which caused or contributed to the failures in her practice on this particular occasion;
• when questioned about her failures, the Registrant was extremely and appropriately remorseful.
52. The Registrant’s failure to engage with the HCPC in these proceedings and to attend this hearing have deprived the Panel of information which could potentially have mitigated the sanction in this case.
53. The case is too serious for the Panel to take no further action. Mediation is not a relevant option.
54. A Caution Order is only suitable for minor instances of misconduct and is not appropriate given that it would provide no protection to service users.
55. A Conditions of Practice Order might have been a practicable option had the Registrant engaged with the HCPC and attended this hearing. However, the Registrant has neither responded to the allegation nor provided the Panel with any information about what she has been doing since the date of the incident, her future intentions with regard to practice as a Social Worker or about her personal circumstances. The Panel was therefore unable to formulate any conditions of practice that would be workable.
56. In all the circumstances, the Panel has decided that the appropriate and proportionate sanction is a Suspension Order for a period of 4 months. This will have the effect of protecting the public, whilst giving the Registrant sufficient time to take remedial steps, to prepare fully for a review of this Order and to demonstrate her intentions with regard to returning to practise as a Social Worker.
57. The Panel considered that the a Striking Off Order would be disproportionate given that the misconduct in question related to a single, isolated incident in an otherwise long and exemplary career as a Social Worker.
58. At the review of this Order, a future Panel may be assisted by the following:
• the Registrant’s engagement with the NMC prior to the review of this order and her attendance at the review hearing to demonstrate that she has reflected on the seriousness of the incident, its potential consequences for the service users, the profession and her own status as a member of a profession;
• information about her current state of health and personal circumstances;
• up to date references and testimonials from any employer and in relation to any work-related activities since the date of this Order.
Order: That the Registrar is directed to suspend the name of Leila Annicki Karhu from the register for a period of 4 months from the date this Order comes into effect.
This order will be reviewed before its expiry on 25 August 2019.
History of Hearings for Ms Leila Annikici Karhu
|Date||Panel||Hearing type||Outcomes / Status|
|25/03/2019||Conduct and Competence Committee||Final Hearing||Suspended|