Ms Maria Mars
Please note that the decision can take up to 5 working days to be uploaded onto the HCPTS website. Please contact one of our Hearings Team Managers via email@example.com or +44 (0)808 164 3084 if you require any further information.
As a registered Practitioner Psychologist (PYL26768) your fitness to practise is impaired by reason of your misconduct. In that:
1. Between 10 March 2017 and 12 May 2017, you did not maintain accurate patient records and/or Autism Spectrum Disorder Assessment Reports, in relation to:
a. Service User 2;
b. Service User 3;
c. Service User 4;
d. Service User 5;
e. Service User 6;
f. Service User 8.
2. Between 23 March and 12 May 2019, you sent unsecured documents containing service user identifiable information between:
a. NOT PROVED
b. Your Westminster City Council email address and your personal AOL email address.
3. The matter’s set out at paragraphs 1 –2 above constitute misconduct.
4. By reason of your misconduct your fitness to practise is impaired.
Service of Notice of Hearing
1. This hearing has been conducted by video conference and the Registrant has participated in the hearing and has been represented by Mr Saad of Counsel. There were no issues regarding service of the notice of hearing.
Amendments to the Allegation
2. On behalf of the HCPC, Ms Lykourgou applied for permission to make amendments to the Allegation. She submitted that the proposed amendments did not change the substance of the Allegation but simply ensured that the Allegation more correctly reflected the supporting evidence by a minor amendment of a date. There was no objection on the part of the Registrant. On 24 August 2020 the HCPC had sent a letter to the Registrant setting out the detail of the proposed amendment. The Panel took into account that the proposed amendment was a minor correction and did not affect the substance of the Allegation. To allow the proposed amendment would cause no prejudice or unfairness to the Registrant. The application to amend was granted and the Allegation in its amended form is shown above.
3. Ms Maria Mars (“the Registrant“) is registered with the Health and Care Professions Council (“HCPC”) as a Practitioner Psychologist. At the times referred to in the Allegation she was employed as a locum Band 8a Psychologist by the Central London Healthcare Trust as part of the health staff within the Learning Disability Partnership.
4. The Registrant was employed as a Psychologist within the Westminster Adult Autism Assessment and Diagnostic Service (“WAAADS“). Within that role, she was responsible for undertaking autism assessments of adult patients for 2 days each week. The period of her employment was from March 2017 to May 2017. Her line manager and clinical supervisor was a Consultant Clinical Psychologist.
5. The HCPC case is that the Registrant met the service users referred to in the Allegation and had responsibility for preparing reports in respect of each of those service users. It is said that psychologists carrying out this type of task would be provided with a template to be followed in preparing such reports and an example report which had been written in respect of a previous service user (“Service User 1”) who is not the subject of the Allegation.
6. In respect of Particular 1, Ms Lykourgou said that the HCPC case was that the Registrant was required to prepare and make available accurate records and reports. The HCPC could not say if the reports she supplied were in a final completed form but could say that the Registrant did not supply them in accordance with her role. The HCPC case was that the Registrant was required to assess service users, to keep up-to-date records, to prepare final reports and make those reports available to her employer and service users but she failed to do so. In respect of Particular 2 the HCPC case was that during her employment, the Registrant emailed, to her own personal email address, unsecured documents containing service user identifiable information.
7. On behalf of the Registrant, Mr Saad asked the Panel to make decisions, and give reasons, on the facts of the case and the question of misconduct as a first stage and then move, if necessary, to the question of Impairment in a second stage. There was no objection from Ms Lykourgou and the Panel agreed to that request.
8. Prior to the hearing, the Panel received a bundle of documents from the HCPC and from Ms Mars. During the hearing they heard evidence in support of the HCPC case from Witness 1 appearing in person by video conference. Witness 1 was, at the relevant times, the Line Manager and Clinical Supervisor of the Registrant. The Panel also heard evidence from the Registrant by video conference.
Decision on facts
9. The Panel made the findings of fact below on the balance of probabilities.
10. At the commencement of the hearing, the Registrant admitted Sub- Particular 2b and denied each of the other Sub-Particulars. Ultimately, it is the responsibility of the Panel to determine whether or not the Particulars of the Allegation are made out but the Panel has taken into account that admission when making its findings.
11. WAAADS operated an electronic clinical record keeping system, Framework 1 (“FWi”). The practice was that a practitioner psychologist would be expected to upload onto the FWi system all completed reports and such an action should be taken within a reasonable period of time of the completion of the report. In addition, paper copies of completed assessments would be stored in a secure cupboard in the office.
12. The Registrant was issued with a laptop on which she could prepare necessary reports. The expectation was that upon completion of any such reports the Registrant would upload the report to the FWi system.
13. In paragraph 11 of her witness statement the Registrant gave an account of aspects of the induction process she went through during her first day of work. An appointment was made for her to attend City Hall on Thursday 16 March 2017 to be set up on the FWi system. The Registrant’s account in her witness statement was that she was not familiar with the system. She had used it before but that was a while before she had started at WAAADS and “even then, it was only for a short time”.
14. The evidence from the Registrant has been “There were ongoing technical difficulties with the laptop I was given. The Administrator was supportive”. She went on to say that although she often experienced problems with the FWi system that the administrative team were also supportive.
15. Throughout the hearing the Registrant has maintained that she completed all required reports and saved them on her work laptop.
16. The Registrant’s last day of work was on Friday, 12 May 2017. On that day she had meetings in the morning with Service Users 4 and 5 and she sat in on a meeting conducted by Witness 1 with Service User 6 during the afternoon.
17. The practice within WAAADS was, usually, to have 3 meetings with a service user during the preparation of a report. At the first meeting, the Practitioner Psychologist would explain the purpose of the assessment and the process that would be followed, and gather background information. At the second meeting an autism assessment would take place. Then the Practitioner Psychologist would complete a draft report prior to the third meeting. At that third meeting, the service user was free to express views about the report content and after that meeting the completed report, with any necessary amendments being uploaded to the FWi system.
18. In his closing submission on the question of findings of fact and misconduct, Mr Saad emphasised that this was not a case where there has been a significant area of dispute between the two witnesses who had given oral evidence. Both were professional and it was unlikely that either of them had come to the Tribunal with the intention of misleading the Panel. In that context he asked the Panel to take into account that the Registrant was new to her position. She worked as a locum. At the time of the Particulars being examined she had been working part time two days a week over a period of 9 weeks. Mr Saad asked the Panel to take into account that no matter how good an induction was it, would take a person sometime to become familiar with a new job and office systems. He asked the Panel to take into account an email sent by the Registrant which indicated she was experiencing IT difficulties. He also asked the Panel to take into account that there were indications that the HCPC had not properly investigated all of the relevant evidence and that the evidence before the Panel had been collated by Witness 1.
19. Mr Saad asked the Panel to take into account that the evidence from Witness 1 was that he had not read everything that was on the Registrant’s emails because at that time he was looking primarily for material which showed the Registrant to be sharing service user information between the WAAADS computer system and her own private email account. Mr Saad asked the Panel to take into account that some of the emails had not been read by Witness 1 because he had been asked by the HCPC simply to show service user information between the WAAADS email system and the Registrant’s personal
email system. Mr Saad stated that it was clear that the HCPC had not scrutinised the case with any rigour.
20. Mr Saad asked the Panel to take into account that the HCPC could not say whether the reports were completed or not. The Registrant had given evidence that on Sunday 14 May she had tried to log onto the server in order to upload the reports but she had been unable to do so. She could not be blamed for that inability.
21. The Panel has heard evidence from Witness 1 as to the checks he made regarding the Registrant’s laptop and the uploading of reports onto the FWi system after the end of the Registrant’s employment. Witness 1 had a personal interest in locating the reports because it was in the interests of the service users for whom he was responsible that he did so. The evidence from Witness 1 has been that he could not locate any trace of what might be seen as completed finalised assessment reports on the Registrant’s work laptop, either on its desktop, or the Registrant’s personal drive, or on the FWi system. The Panel also heard evidence from Witness 1 that he was unable to locate in the secure storage cupboard any copies of completed paper assessment forms in respect of the six service users assessed by the Registrant.
22. What he found attached to emails were reports relating to SU2 which were only partly completed and were not of a professional standard, or in a form that could be issued to the service user, or form part of their clinical record. The report appeared to be an amalgam of information relating to SU2 and other service users. He also found what appeared to be reports relating to the other 5 service users which, again, were an amalgam of information relating to different service users and which could not be issued to the relevant service users. That is because, to a very great extent, they simply repeated the information referred to above relating to SU2.
23. The Panel has accepted the evidence from Witness 1 as reliable and fair and where he could not remember something he said so. In particular, he gave a clear account of his examination and search for completed reports on both the Registrant’s work laptop and the FWi system.
24. The Panel has taken into account in making findings of fact that the Registrant has a professional history and experience of more than 20 years. There is no evidence of any past professional concerns. She
has an impressive CV. She is an experienced practitioner who has worked in various Practitioner Psychologist fields.
Between 10 March 2017 and 12 May 2017, you did not maintain accurate patient records and/or Autism Spectrum Disorder Assessment Reports, in relation to:
a. Service User 2;
b. Service User 3;
c. Service User 4;
d. Service User 5;
e. Service User 6;
f. Service User 8.
25. This Particular asserts that the Registrant did not maintain accurate records or reports. The Panel is satisfied that an integral part of that responsibility was not only to complete an individual report, but also, importantly, to upload any such report on the FWi system. That was important because if other practitioners wanted to have information regarding a particular service user that information would be obtained, not from a Practitioner Psychologist’s individual laptop, but from the centralised FWi system.
26. The Panel had particular regard to the evidence of Witness 1 and it is clear to the Panel, on the balance of probabilities, that in the case of each of Service Users 2, 3, 4, 5, 6 and 8 each report was never uploaded by the Registrant to the FWi system.
27. The Registrant’s account has been that she had completed all reports and that on the weekend of 13 and 14 May 2017 she had attempted to check that they were on FWi, but was unable to access the electronic clinical record system. The Panel noted that the Registrant took no action to inform her Line Manager that she had been unable to check that her outstanding completed reports were on FWi.
28. The Panel is satisfied that the reports in those cases were not uploaded to the FWi system. The Panel is also satisfied that the Registrant had adequate time to do so. The Registrant has not been able to give any reliable account as to why the reports were not on the FWi system. As it is noted above, the Panel sees the uploading of completed and accurate reports as an integral part of the system of
maintaining accurate clinical records. The Registrant did not fulfil this task and has given no reliable reason for not doing so. On that basis, the Panel finds that the Particular in respect of each of these service users is proved.
29. The Panel has taken into account that the Registrant, on the last day of her work, met Service Users 4 and 5 for feedback meetings and sat in on a meeting that Witness 1 was having with Service User 6. The Panel has considered whether, in those circumstances, the Registrant would have had reasonable time to upload the completed reports. The evidence from the Registrant has been that the relevant reports were already complete before meeting those service users and the meetings did not create a necessity to alter the reports that she had already prepared.
30. On the evidence submitted the Panel is satisfied that the process of uploading reports was relatively simple. The Panel has concluded that in respect of Service Users 4, 5 and 6 there was adequate time on the last day of employment to upload the completed reports. On that basis the Panel has concluded, in respect of each of service users 2, 3, 4, 5, 6 and 8 that each of the Sub-Particulars is proved.
31. Therefore Particular 1 is found proved in full.
Between 23 March and 14 May 2017, you sent unsecured documents containing service user identifiable information between:
a. Your North East London Foundation Trust (NELFT) email address and your personal AOL email address;
b. Your Westminster City Council email address and your personal AOL email address.
32. With regard to Particular 2a this has been denied by the Registrant and this Particular looks specifically at emails sent by the Registrant on 22 March 2017 and 23 March 2017. The first of those was sent from the Registrant’s NELFT email address (which was an NHS email address available to the Registrant) to her personal email address. It is clear that the Registrant forwarded that email from her personal email address to her WAAADS email address. It is also clear that at some
point during that email transmission process, an attachment was made to the email which concerned SU2. The difficulty for the Panel is that there is no clear way to identify whether the attachment was made to the first email moving from the NELFT address to the personal email address or to the second email moving from the Registrant’s personal email address to WAAADS.
33. In those circumstances, the Panel finds that the HCPC has not shown on the balance of probabilities that documents containing service user identifiable information were attached to the email moving from NELFT to the personal email address. On that basis this Sub-Particular is not proved.
34. With regard to Particular 2b the Panel has taken into account that this has been admitted by the Registrant and the Panel has also found it proved.
35. The Panel has seen the relevant screenshots of emails. It is clear to the Panel that the Registrant did email service user identifiable information between her WAAADS email address and her personal email address. The Panel is satisfied that the material showed, in some cases, the name of a service user or an abbreviation of that name. The Panel is satisfied that the use of a name was clearly identifiable information and that can be reasonably said of the abbreviation used by the Registrant.
Decision on Grounds
36. The Panel has taken misconduct to mean an act or omission that amounts to a serious breach or a serious falling short of professional standards.
37. The Panel is of the opinion that the obligation to respect patient confidentiality is a fundamental tenet of the practice of a Practitioner Psychologist. The relevant service users were fully entitled to expect that service user identifiable information would be treated with the utmost confidentiality. That did not happen.
38. In the Panel’s view the responsibility to ensure clinical records are accurately completed and securely and appropriately stored are also fundamental requirements of the clinical practice of a Practitioner Psychologist. The Registrant did not fulfil this requirement.
39. The Registrant was dealing with adult service users who were thought possibly to be experiencing autism. It was likely that such service users had not previously been diagnosed as experiencing autism and had not earlier in life been provided with appropriate support. The waiting time for undertaking necessary assessments was measured in months. Those service users would undoubtedly be experiencing a considerable degree of anxiety. The effect of not uploading completed accurate clinical reports was that those service users were caused significant delay in confirming their diagnosis because they had to undergo a further assessment.
40. The Panel is satisfied that the acts and omissions on the part of the Registrant amounted to a failure to comply with the following Standards:
HCPC Standards of Conduct, Performance and Ethics:
5.1 You must treat information about service users as confidential;
10.1 You must keep full, clear, and accurate records for everyone you care for, treat, or provide other services to;
10.2 You must complete all records promptly and as soon as possible after providing care, treatment or other services;
10.3 You must keep records secure by protecting them from loss, damage or inappropriate access.
HCPC Standards of Proficiency for Practitioner Psychologists:
7.2 understand the principles of information governance and be aware of the safe and effective use of health, social care and other relevant information;
10.1 be able to keep accurate, comprehensive and comprehensible records in accordance with applicable legislation, protocols and guidelines;
10.2 recognise the need to manage records and all other information in accordance with applicable legislation, protocols and guidelines;
41. The Panel has concluded that the acts or omissions of the Registrant in the case of both of the Particulars of the Allegation found proved were clearly serious and amounted to misconduct.
Adjournment 4 November 2020
42. At this point the hearing adjourned as there was not enough time left to properly consider the next stage.
43. The Panel requested that 2 days be allocated to conclude this hearing. It is hoped that the hearing will resume on 17 and 18 December 2020. These dates are to be confirmed by the Health Care Professions Tribunal Service.
44. The Panel has considered the guidance in the HCPTS Practice Note on Fitness to Practise Impairment. The Panel’s task is to assess current fitness to practise.
45. In determining fitness to practise allegations, Panels must take account of two broad components: the ‘personal’ component and the ‘public’ component.
46. The personal component is the current competence, behaviour etc. of the registrant concerned. The public component refers to protecting service users; declaring and upholding proper standards of behaviour; and maintaining public confidence in the profession concerned.
47. The key questions which need to be answered are:
• are the acts or omissions which led to the allegation remediable?
• has the Registrant taken remedial action?
• are those acts or omissions likely to be repeated?
48. The Panel carefully considered the first three limbs of the test set out by Dame Janet Smith in the fifth Shipman Report which were re-stated in Grant, namely:-
“Do our findings of fact in respect of the doctor's misconduct, deficient professional performance, adverse health, conviction, caution or
determination show that his/her fitness to practise is impaired in the sense that s/he:
1. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or
2. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or
3. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or
4. has in the past….”
49. On behalf of the HCPC Ms Lykourgou asked the Panel to take into account the Fitness to Practice Impairment Practice Note. She referred to the factors identified in the case of Grant which had been drawn from the fifth Shipman Report. There was a past and present test to be considered. The HCPC position was that the Registrant had created a past risk to service users and the likelihood was that there would also be a future risk. It was accepted that the Registrant’s actions did not put patients directly at risk of harm but those actions did put service users in distress. They were in a category of service user who had waited a long time for treatment and the nature of their medical condition meant that they would be disturbed by the fact that a report they had thought would be prepared was not later available.
50. The Panel was also asked to accept that the Registrant had brought disrepute onto her profession by the manner in which she had acted, as that had been identified by the Panel in paragraphs 36 to 38 of the Decision. Further, the training material produced by the Registrant was insufficient to demonstrate adequate learning in respect of electronic record keeping responsibilities. There had been no written reflections from the Registrant in that respect. The Registrant had referred to having group sessions but she had not produced a great deal of evidence on that point.
51. Ms Lykourgou continued by asking the Panel to find that the public component factors fell to be considered. The evidence from the Registrant was that she had not been familiar with the particular record keeping system. Therefore there would be a failure to maintain confidence in the Practitioner Psychologist profession if there were to be no finding of impairment. Ms Lykourgou also provided written submissions which the Panel have taken into account.
52. On behalf of the Registrant Mr Saad asked the Panel to take into account the employment history of the Registrant. She had 30 years of work experience with 26 of those years as a Clinical Psychologist. The Panel had already found the Registrant to hold an impressive CV and to have considerable experience. About 3 1/2 years had passed since the events being examined by the Panel during which the Registrant had been in employment until March 2020. Throughout the Registrant’s employment history there had never been any other regulatory concerns. Mr Saad submitted that in her witness statement the Registrant had expressed insight and remorse. She had given oral evidence for the best part of a day at the fact finding stage and had told the Panel that her future actions would not be the same as the actions that had been examined by the Panel.
53. Mr Saad asked the Panel to take into account the CPD material that had been re-submitted to the Tribunal the previous day. That material demonstrated the continuing CPD undertaken by the Registrant which included CPD on the duties and proper practice of record keeping. The Panel was also asked to take into account the value of the Registrant’s current employment with a charity supporting children in which the Registrant was working with prospective adopters of a three-year-old child.
54. Mr Saad drew attention to the reference provided by an Independent Social Care Consultant who was highly experienced and who had known the Registrant since 1993. He submitted that the reference showed the Registrant to be reliable, trustworthy, responsible and highly respected by her peers and a person who demonstrated integrity, professionalism and skill.
55. The Panel was asked to accept that in May 2017 there had been a lapse by the Registrant but there had been no other issues in a long career. It was accepted that the actions on the part of the Registrant were serious and wrong but they would not be repeated and there was a strong public interest in continuing the Registrant’s career.
56. Mr Saad asked the Panel to consider the personal component and to accept there was no current risk to service users and that she had demonstrated insight and remorse. It should not be held against the Registrant that she had denied some of the Allegation.
57. The Panel was asked, when looking at the public interest grounds, to take into account there was always a spectrum of seriousness. There was no deep-seated attitudinal problem on the part of the Registrant and the fact was that people could always make mistakes. Mr Saad asked the Panel, in summary, to accept that this had been a lapse on the part of the Registrant during a very limited period of employment and when looked at against the background of her very long and creditable employment history was not sufficient for a finding of impairment.
58. When examining the personal component the Panel has taken into account the degree of insight, remorse and remediation on the part of the Registrant, the information provided by her as to her subsequent CPD and the single testimonial from a colleague who appears not to have worked with her since for some considerable time.
59. The Registrant has provided title pages of web material dealing with the Data Protection Act and GDPR and extracts from Guidance issued by the British Psychological Society on Electronic Record Keeping.
60. The Panel noted that the Registrant recorded on her CPD log that she had read documents relating to data protection and standards of proficiency between May and June 2017. Despite this in her witness statement she indicated that in future she would send copies of reports to the administrator to ensure these matters concerning her conduct would not arise again. The Panel therefore considers that despite undertaking this CPD she has not demonstrated insight that it is her responsibility to follow the record keeping protocols of her employer to ensure the safe storage of service user information on the local record keeping system. The Panel was concerned that in the Registrant’s reflective evaluation of mandatory training on electronic record keeping systems in August 2019 she made no reference to how her skills or competence in using electronic record systems had developed or improved.
61. In her witness statement the Registrant had stated that she had attended reflective practice groups and focused on possible mistakes and lessons learned, but neither here or in her CPD log does she provide any detail on what information she shared and specific insights gained relevant to these allegations. The Panel in their questions tried to determine with the Registrant why she did not complete the patient records and why she sent patient records to her own personal email address. Despite several questions the Registrant was unable to give
an explanation. Furthermore, the Panel considered that both in the Registrant’s oral evidence and in her written statement there is limited evidence of insight by the Registrant into her unsafe action in sending service user identifiable information to her personal email address.
62. The Panel has considered the long employment history of the Registrant, particularly her continuing employment since the date of the events in 2017.
63. The misconduct being considered by the Panel is:
• a failure to properly maintain adequate patient records by not uploading reports to the central electronic records system, and
• the sending of unsecured documents containing service user identifiable information to the Registrant’s personal email address.
64. The task of the Panel is to assess the likelihood that the Registrant would commit such acts or omissions in the future. The fact of the long employment history, the CPD undertaken by the Registrant and the testimonial obviously plays a part in that assessment.
65. However, the Panel notes that the majority of the CPD does not relate to managing record keeping. The Registrant has held a number of posts since the events being considered by the Panel but there are no references from any of those employers or supervisors as to the Registrant’s capability in using electronic record keeping systems or protecting patient confidentiality.
66. The Panel is satisfied that the acts and omissions on the part of the Registrant are remediable. The Panel finds that the Registrant has taken limited remedial action. On the basis of the points made in the previous paragraphs the Panel does not accept that the Registrant has developed adequate insight.
67. The Panel takes the view that with only limited insight that does not demonstrate that the Registrant properly understands how the past acts and omissions occurred nor the full impact of the consequences of her misconduct. The Panel is also of the view that the Registrant has not taken sufficient action to address past failures and omissions. These factors are all relevant to the Panel’s assessment.
68. The Panel has concluded that, at the moment and without complete insight and remediation, there is a risk that the past acts or omissions are likely to be repeated. On that basis, the Panel is satisfied that the personal component factors are present in this case.
69. The Panel has gone on to consider the public component factors. On the basis of the above analysis the Panel is satisfied there remains a need to protect service users. In addition, the Panel is also satisfied that if there were no finding of impairment a reasonably informed member of the public would consider there had been a failure to declare and uphold proper standards of behaviour and a failure to maintain public confidence in the Practitioner Psychologist profession.
70. As a consequence, the Panel has concluded that the fitness to practise of the Registrant is impaired on both the personal component and the public component.
71. Ms Lykourgou summarised the Sanctions Policy and confirmed that it was accepted by the HCPC that the Registrant had been practising for a number of years with no previous HCPC concerns about her suitability to practise. It was also accepted by the HCPC that the Registrant had in the past carried out necessary CPD. Ms Lykourgou highlighted the limited degree of the Registrant’s insight and remediation. Ms Lykourgou suggested that the key issue was whether the Registrant had properly addressed her shortcomings regarding record keeping and IT systems. The HCPC position was that if the Panel were to be satisfied that the Registrant had a genuine commitment to remediate her practice, then an order of Caution or Conditions of Practice may be appropriate. The HCPC did not see this as a case where an order of Suspension or Striking off was appropriate.
72. On behalf of the Registrant, Mr Saad submitted that this was a classic case for a Conditions of Practice Order. He suggested that the failings and omissions of the Registrant were remediable. The purpose of sanction was not to punish but to protect members of the public. In a case where the previous failings were remediable and the Registrant was engaging in the regulatory process, and also had a long career without previous concerns, then a Conditions of Practice order would be the appropriate and proportionate outcome. Mr Saad referred to the
factors set out in paragraph 106 of the Sanctions Policy and suggested that all of the factors were present in this case. He also suggested that there was nothing to show that the Registrant was not likely to comply with Conditions of Practice. Despite the Panel’s finding that, currently, the Registrant’s insight was limited, if she were to practise under appropriate supervision that would provide adequate future protection for service users. Mr Saad submitted that it was relevant that the Panel take into account the number and type of posts held by the Registrant since May 2017. There was no evidence of any other failings during that more recent employment. That was an indication of the level of risk in the future. A Conditions of Practice Order would give the Registrant an opportunity to continue her remediation journey.
73. The Panel took into account the HCPC Sanctions Policy. The purpose of sanctions is not to be punitive, although they may have that effect. The primary purpose of a sanction is to ensure public safety. However, a Panel must also give appropriate weight to wider public interest factors which include: the deterrent effect for other registrants, the reputation of the profession concerned, and public confidence in the regulatory process. Further, a Panel must act proportionately in striking the proper balance between the interests of the public and those of a registrant.
74. In considering an appropriate sanction a Panel should impose the sanction that provides an adequate and proportionate balance between
(i) public safety and the other public interest factors referred to above and (ii) the Registrant’s ability to practise his or her profession.
Mitigating and aggravating features
75. The mitigating features are:
• the absence of any other HCPC concerns during a lengthy career
• the Registrant has fully engaged with these proceedings
76. The aggravating features are:
• limited insight
• limited remediation
• a lack of recent testimonials giving an opinion about the Registrant’s understanding and application of proper standards of record keeping and the maintenance of patient confidentiality
• the negative impact of the Registrant’s acts and omissions on the 6 vulnerable service users who would have experienced distress, anxiety and delay in diagnosis
• the negative impact, including wasted resources and increased waiting times for other service users and damage to reputation, on the Service who had to repeat the assessment process of those 6 service users.
77. The Panel first considered a referral for Mediation but concluded that such an order would not address the deficiencies on the part of the Registrant.
78. The Panel next considered a Caution Order. Such an order is likely to be an appropriate sanction for cases in which:
• the issue is isolated, limited, or relatively minor in nature;
• there is low risk of repetition;
• the registrant has shown good insight; and
• the registrant has undertaken appropriate remediation.
79. The Panel decided, having regard to the findings above in respect of misconduct, that none of the above factors were present in this case. A Caution Order would not provide an assurance that the Registrant was continuing to develop insight and remediation. The Panel concluded that a Caution Order was not suitable in this case.
80. The Panel next considered a Conditions of Practice order. Such an order is likely to be appropriate in cases where:
• the registrant has insight;
• the failure or deficiency is capable of being remedied;
• there are no persistent or general failures which would prevent the registrant from remediating;
• appropriate, proportionate, realistic and verifiable conditions can be formulated;
• the panel is confident the registrant will comply with the conditions;
• a reviewing panel will be able to determine whether or not those conditions have or are being met; and
• the registrant does not pose a risk of harm by being in restricted practice.
81. The Panel was satisfied that all of the above factors are present in this case and that a Conditions of Practice Order would be the suitable and proportionate Order. The Panel was satisfied that the correct and proportionate term of the Order was 12 months. That would be a sufficient period of time for the Registrant to meet the requirements in the Conditions of Practice Order set out below.
82. The Panel was satisfied that a Suspension Order would not be appropriate. Having regard to the findings made by the Panel, such an order would be punitive and disproportionate. It would bar the Registrant, who has had an otherwise unblemished career, from practising which is not in the public interest.
83. The Panel announced conditions of practice which required the Registrant to take actions within certain time limits. Mr Saad asked the Panel to take into account the practical impact of the timescale within the current Conditions of Practice as presently drafted and the impact of the Christmas break on the Registrant’s ability to comply with those Conditions. He asked the Panel to consider making an amendment to the time within which the Registrant had to take action.
84. The Panel indicated to the parties that an amendment to the timescale would be considered. The Panel agreed to amend the Conditions of Practice as originally announced and the amended Conditions are as shown below.
ORDER: The Registrar is directed to annotate the HCPC Register to show that, for a period of 12 months from the date that this Order takes effect (“the Operative Date”), you, Ms Maria Mars, must comply with the following conditions of practice:
1. By 1 February 2021 you must place yourself under the supervision of an HCPC registered Practitioner Psychologist and work with them to formulate, implement and review a Personal Development Plan to address shortcomings in:
• Your understanding of the expectations of a Clinical Psychologist with regards to record keeping, with particular reference to the use of centralised electronic or paper based multidisciplinary record systems.
• Your understanding of the risks to client confidentiality in relation to the storage and transmission of client information.
2. You must provide details of your supervisor to the HCPC by 1 February 2021. Should that supervisor change at some point you must inform the HCPC of their details within 14 days of the change.
3. You must provide a copy of the Panel’s Decision to any supervisor.
4. You must provide a copy of your Personal Development Plan, and any update or review of it and relevant CPD undertaken to the HCPC at least 14 days before any review of this Order.
5. For a period of a minimum of six months you must maintain a log of your caseload specifying for each service user the mechanism and date pertaining to your recording of client information. You must provide a copy of this log, suitably redacted, to the HCPC at least 14 days before any review of this Order.
6. You must provide from your supervisor a report on your progress with respect to (1) which you must submit to the HCPC at least 14 days before any review of this Order.
7. You must provide to the HCPC within the next 3 months a reflective statement considering:
• The impact of the shortcomings in your practice on the service users involved, your colleagues at the time and the wider public interest.
• Your progress in developing the insight and capabilities to ensure no repetition of the misconduct found.
8. 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 undertake professional work;
b) any agency you are registered with or apply to be registered with (at the time of application) and any prospective employer (at the time of your application).
9. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.
10. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.
This Order will be reviewed before its expiry by a different Panel before it expires. It is not appropriate for this Panel to limit the discretion of any future Panel but the Reviewing Panel is likely to be assisted by the Registrant attending the future Review Hearing (remotely if appropriate) and producing all the documentation required by the Conditions of Practice within the time limits specified.
Right of Appeal
You may appeal to the High Court in England and Wales against the Panel’s decision and the order it has made against you.
Under Article 29(10) of the Health Professions Order 2001, any appeal must be made within 28 days of the date when this notice is served on you. The Panel’s order will not take effect until the appeal period has expired or, if you appeal, until that appeal is disposed of or withdrawn.
European Alert Mechanism
In accordance with Regulation 67 of the European Union (Recognition of Professional Qualifications) Regulations 2015, the HCPC will inform the competent authorities in all other EEA States that your right to practise has been restricted.
You may appeal to the County Court against the HCPC’s decision to do so. Any appeal must be made within 28 days of the date when this notice is served on you. This right of appeal is separate from your right to appeal against the decision and order of the Panel.
Ms Lykourgou applied for an Interim Conditions of Practice Order. She referred to the statutory grounds that had to be present. Mr Saad did not object in principle to such an order.
A Panel may only make an interim order if it is satisfied that:
• it is necessary for the protection of members of the public; and/or
• it is otherwise in the public interest; and/or
• it is in the interests of the registrant concerned. The maximum period of any such order is 18 months.
The Panel takes into account its findings in the Decision. The Registrant’s fitness to practice is currently impaired. If no interim order is made that will have the effect that during the period that is open to the Registrant to appeal against the Panel’s decision there would be no restriction on the Registrant’s practice. The Panel is satisfied that that situation would create a risk for members of the public and would not otherwise be in the public interest. On that basis the Panel has concluded that an interim order is appropriate and that the order should be an Interim Conditions of Practice Order.
The conditions in the Interim Conditions of Practice Order shall be the same as the conditions in the substantive order as shown above.
History of Hearings for Ms Maria Mars
|Date||Panel||Hearing type||Outcomes / Status|
|17/12/2020||Conduct and Competence Committee||Final Hearing||Conditions of Practice|
|02/11/2020||Conduct and Competence Committee||Final Hearing||Adjourned part heard|