Dr Paul F J Fleming
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The following Allegation was considered by a Panel of the Conduct and Competence Committee at a Substantive Hearing on 28 to 31 January 2019 and 1 to 2 August 2019.
During the course of your employment at NHS Greater Glasgow & Clyde (Adult Mental Health) and while registered as a Practitioner Psychologist, on dates between 3 July 2012 and 31 August 2015, you:
1. On dates between 31 July 2014 and 18 September 2014, you did not follow appropriate statutory safeguarding procedures, in that;
a) Following a disclosure on 31 July 2014, by Patient Five, of historic sexual abuse by a general practitioner to your supervisee, Colleague F, you:
i. during supervision you did not advise Colleague F that the matter should be reported;
ii. [not proven]
b) When Colleague F reported her concerns to her Clinical Tutor and Local Area Tutor in September 2014, you were instructed to raise the matter with Patient Five and the Police, but:
i. did not do so until November 2014;
ii. did not respond to emails from Colleague F regarding the appointment with Patient Five until instructed by a senior colleague.
2. Did not manage and/or record patient care in an appropriate manner, in respect of:
a) Patient One, in that you:
i. did not make arrangements for community CBT as discussed with Patient One;
ii. i. did not write a discharge letter to Patient One’s GP.
b) Patient Two, in that you left the case file open without recording any notes and/or contacts despite approximately 35 contacts being recorded as attended on the electronic diary system between 03 July 2012 and 31 August 2015.
c) Patient Three, in that you tested and assessed Patient Three, but:
i. [not proven]
ii. did not record the results of the tests in the case notes;
iii. did not record an assessment letter and/or final report;
iv. did not make any notes of any consultations with the patient for approximately 16 appointments.
d) Patient Four, in that you did not:
i. complete the assessment report and/or;
ii. communicate the outcome of the assessment to Patient Four.
3. On dates between April 2014 and 8 September 2014, while supervising a Student Psychologist, Colleague F, you:
a) Did not ensure Colleague F had a caseload suitable for her development needs;
b) Did not provide a suitable induction, in that you:
i. did not set out risk management strategies;
ii. did not agree a suitable framework for supervision.
c) Did not structure your supervision sessions appropriately.
d) [not proven]
e) Did not complete and/or contribute to the placement outcomes documentation at the end of the Placement.
4. The matters set out in particulars 1 - 3 above constitute misconduct and/or lack of competence.
5. By reason of that misconduct and/or lack of competence your fitness to practise is impaired.
The panel found the following facts proved: 1(a)(i), 1(a)(ii), 1(b)(i), 2(a)(i), 2(a)(ii), 2(b), 2(c)(ii), 2(c)(iii), 2(c)(iv), 2(d)(i), 2(d)(ii), 3(a), 3(b)(i), 3(b)(ii), 3(c) and 3(e), these amounted to miscoduct, and the Registrant’s fitness to practise to be impaired. A Conditions of Practice Order for a period of 12 months was imposed as a sanction.
1. The Registrant was a Band 8C Consultant Clinical Psychologist with NHS Greater Glasgow and Clyde, from 2000 until August 2015. During the time that the concerns were raised, the Registrant was based at Auchinlea Community Mental Health Team working with adults with moderate to severe and/or complex mental health problems.
2. The Registrant was also a Trainee Supervisor. He supervised, at the relevant time, a trainee clinical psychologist under a mini-placement and concerns were raised in relation to this supervision.
3. Concerns were also raised that the Registrant had not followed the correct procedure in reporting a matter to the police when advised by his supervisee that a service user had made a disclosure of historic sexual abuse.
4. Following these concerns, the Registrant’s then line manager conducted an internal investigation into the Registrant’s conduct and a formal capability meeting took place on 4 March 2015. The Registrant left his post in or around September 2015. Shortly after his departure concerns were raised about some of his cases.
5. At a hearing of the Health and Care Professions Tribunal, which concluded in August 2019, a Panel of the Conduct and Competence Committee found the majority of the allegations proved, and determined that the Registrant’s Fitness to Practise was impaired. The Panel imposed a conditions of practice order for a period of 12 months in the above terms.
6. The Registrant did not attend this hearing because of the time difference between Guam, where he is currently based, and his working commitments. Ms Tanchel assured the Panel that the Registrant intended no discourtesy in not attending today’s hearing. She confirmed
that she had taken instructions from him and he was content for the matter to proceed in his absence.
7. Ms Simpson for the HCPC set out the relevant background to the matter and noted that the Registrant was currently working at the University of Guam, as he had been at the time of the Final Hearing. Although the conditions only had effect whilst the Registrant was working in the UK, she submitted that in order to consider whether the Registrant’s fitness to practise was impaired it was relevant to consider to what extent he had addressed the concerns that led to the imposition of the conditions of practice order. She submitted that the reflective piece (Statement of Reflection) provided by the Registrant in the defence bundle did not fully address the impact of his conduct on service users, colleagues and the public, which the Final Hearing panel had suggested would assist a future reviewing panel. She noted that the courses he had undertaken had been completed late in the day. The Registrant had not provided any evidence of the content of these courses. Ms Simpson further submitted that the Registrant’s Personal Development Plan (PDP) did not address the specific deficiencies identified in his practice and appeared to come from a position that his practice was good to start with and would continue to be so. Ms Simpson also drew the Panel’s attention to recent correspondence from the Registrant’s Dean, Professor JS, which raised the possibility that the Registrant may not have been fully transparent with his current employer about his conditions of practice. The HCPC had sent a copy of the decision from the Registrant’s Final Hearing to Professor JS, who had commented that “many of the issues…persist”. Ms Simpson submitted that all of these factors suggested that the Registrant lacked complete insight and had not taken sufficient steps in remediation for the Panel to be reassured that such conduct would not recur. Ms Simpson submitted that the appropriate course of action would be to extend the current conditions of practice order for a further period of twelve months.
8. Ms Tanchel, on behalf of the Registrant, informed the Panel that the Registrant had done his utmost to comply with the conditions even though he was not technically required to do so in his current post, which was outside the jurisdiction. She submitted that the Registrant took his obligations very seriously and was keen to engage with his regulator to demonstrate that his fitness to practise was no longer impaired. She contended that the Registrant’s fitness to practise was not currently impaired. She drew the Panel’s attention to the bundle of documents submitted by the Registrant. The Registrant had provided completion
certificates for the three courses he had attended on documentation & record keeping, safeguarding children and supervising others. These had all been undertaken online. Two courses were undertaken on 21 July 2020 and the third was undertaken on 22 July 2020. The Registrant had submitted his PDP to the HCPC, in October 2019 and, in his bundle, he had also provided testimonials from colleagues and students he had supervised together with a nomination letter and certificate for the Graduate Faculty Award he received in June 2020.
9. In regard to the Dean’s recent comments, Ms Tanchel advised that these had taken the Registrant completely by surprise. He had not been made aware of any concerns in his current post and it was disputed that he had not made his employer aware of matters. In this latter regard, Ms Tanchel referred to the testimonial, dated July 30, 2020, from Drth KS who had been the Registrant’s academic Division Chair and who confirmed that the Registrant had shared the directives from the HCPC of 2 August 2019 with him. Ms Tanchel further submitted that it was unfair to draw any negative inference from the late completion of the courses. The Registrant was a full time academic with many commitments; the fact that the courses had been undertaken recently meant that any learning was fresh. Ms Tanchel contended that the PDP and reflective piece set out the full insight demonstrated by the Registrant.
10. The Panel considered the submissions of the parties, together with all of the evidence it had before it. The Panel accepted the advice of the Legal Assessor and had regard to the HCPTS Practice Note ‘Finding that Fitness to Practise is Impaired’.
11. The Panel exercised its own professional judgement when considering whether the Registrant’s fitness to practise is currently impaired. The Panel was mindful that the conditions of practice did not strictly apply to the Registrant’s practice outside the jurisdiction but nevertheless considered it was relevant to look at his compliance with those conditions in order to be satisfied as to whether the concerns that led to the imposition of the original order had been addressed.
12. The Panel concluded that the Registrant had not sufficiently addressed the concerns that led to the imposition of the conditions of practice order in his reflective statement. The Panel considered that the Registrant had failed to properly demonstrate an appreciation of the impact his conduct may have had on those he supervised in relation to their future progression and their trust in the supervision process. In addition, the Panel considered that the Registrant had failed to demonstrate in his reflective statement any appreciation of the effect that his conduct, both in his clinical practice and as a supervisor, may have had on patients, the wider public interest and the reputation of the profession.
13. The Panel noted the PDP submitted by the Registrant in October 2019 and the “updating notes” included in the defence bundle which had been received the previous day. The Panel considered that the PDP was lacking in a number of key areas. In particular, there was no evidence of embedded learning in the Registrant’s practice. The PDP had been submitted to the HCPC in October 2019 and there was no up to date evidence of the Registrant’s progression against the objectives of that plan, nor any evidence-based examples of how the Registrant had applied any development to his professional practice. There was no external scrutiny of the plan, nor any evidence that the Registrant’s development had been objectively assessed by a supervisor or other clinical mentor. The PDP and “updating notes”, in the Panel’s view, amounted to little more than assertions by the Registrant that issues had been addressed, with insufficient evidence in support.
14. The Panel considered that, although the Registrant had undertaken courses in compliance with the conditions, the effect of completing them a matter of days before the hearing meant that he was unable to demonstrate any applied learning. The Panel was concerned that the courses were limited in nature, especially in relation to safeguarding and record keeping given that these were completed on the same day. The Panel noted that the Registrant undertook the record keeping course on 21 July and his completion certificate was timed at 1.36pm. The certificate for the safeguarding course was timed as completed by 3pm on the same day. There was no evidence that the Registrant had undertaken a course relating to the safeguarding of adults which was the subject of some of the concerns.
15. In the absence of embedded learning, together with the lack of evidence- based examples that the Registrant has fully addressed all of the concerns in his practice, the Panel considered that there remains a risk of repetition of the concerns that led to the substantive order. The Panel concluded that the Registrant’s fitness to practise is currently impaired on public protection grounds.
16. The Panel noted the email dated 13 July 2020 from Professor JS, which Ms Simpson had drawn to its attention. Professor JS had written that “My major concern is that Dr Fleming did not fully disclose the allegations to the University, and he made no mention of the finding”. The Panel acknowledged that it was Ms Tanchel’s contention that the Registrant had informed his employer. It was not clear to the Panel whether Dr KS was in the Registrant’s formal reporting line at the time he shared the Final Hearing decision with him. No light could be shed on this at this hearing. The Panel also gave consideration to Professor S’ comment that “Many of the issues, such as no or very late recording of client records, slow or no response to email messages, poor student advisement/mentoring, persist”. The Panel noted that no evidence in support of these points had been provided and Ms Tanchel had submitted that no concerns or complaints had ever been made in relation to Dr Fleming’s practice at the University of Guam. Ms Tanchel had submitted that the Panel should regard Professor S’ email either as irrelevant or as being of very little materiality indeed. The Panel determined that, in all the circumstances, it would attach little weight to points made in Professor S’ email.
17. The Panel also considered the public interest in upholding proper professional standards and considered that a finding of current impairment on public interest grounds was also required. The public would expect the regulator to act in circumstances where there was a risk of repetition of concerns that had the potential to cause patient harm.
18. Having determined that the Registrant’s fitness to practise remains impaired the Panel went on to consider what order was appropriate. It had regard to the need to act proportionately and to balance the public interest with the Registrant’s own interests.
19. The Panel first considered allowing the order to lapse but concluded that this would be inappropriate given the risk of repetition identified. A caution order would not restrict the Registrant’s practice and the Panel therefore considered this was also not appropriate to protect the public.
20. The Panel then considered whether a further conditions of practice order was appropriate. The Panel considered that the concerns were remediable and that the Registrant had taken some steps to comply with the conditions and address the deficiencies. The Panel noted that the Registrant was working outside the jurisdiction and access to face to face courses and other resources may therefore have been more difficult.
21. The Panel considered that the Registrant was developing insight. He had made efforts to address some of the concerns and appeared to have been practising without further formal concerns being raised during the period that these conditions have been in force.
22. The Panel considered that the Registrant appeared willing to comply with the conditions and, in particular, had sought to do so even though not strictly required to in his current position. The Panel accepted that the Registrant was committed to improving his practice and had accessed some training, albeit the process of remediation and personal development was not yet complete. The Panel considered that it could formulate conditions which protected the public and addressed the public interest issues raised in this case.
23. The Panel considered that a suspension order was disproportionate at this stage and considered that the Registrant should be given a further opportunity to demonstrate that he can remediate the remaining concerns and return to safe unrestricted practice.
24. The Panel concluded that, in all the circumstances, the appropriate and proportionate sanction to impose is a continuation of the current order of conditions for a further period of 6 months with amendments to reflect the current position, as set out below. The Panel considered that a period of 6 months would allow the Registrant a further opportunity to demonstrate that he had fully appreciated the concerns and remedied the deficiencies.
25. The Panel reminded the Registrant that the Conditions of Practice would be reviewed before their expiry. A future reviewing panel might be assisted by the Registrant’s attendance at that hearing together with the following information/documents:
⦁ Testimonials (including from the Registrant’s current employer) which comment on record keeping, supervision and safeguarding issues.
⦁ An evidence based progress report from the Registrant’s supervisor in respect of his progress with the PDP.
⦁ Information about any further courses or relevant training attended.
26. The Panel imposed the below conditions of practice order for a period of 6 months.
ORDER: The Registrar is directed to annotate the Register to show that, for a period of six months from the date that this Order comes into effect (“the Operative Date”), you, Paul Fleming, must comply with the following conditions of practice:
1.You must satisfactorily complete courses relevant to healthcare professionals in:
ii. Safeguarding of adults and Disclosure
2. You must promptly inform the HCPC if you take up any other or further employment.
3. You must promptly inform the HCPC of any disciplinary proceedings taken against you by any employer.
4. 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
c) any prospective employer (at the time of your application).
5. You must work with a clinical supervisor, to formulate a Personal Development Plan to address the following areas:
⦁ Standard of your record keeping;
⦁ Safeguarding of children and adults and disclosure responsibilities
⦁ Quality of your supervision of trainees and students
6. You must meet (either electronically or face to face) with the supervisor referred to in condition 5 above regularly to consider the aims as set out in your personal development plan.
7. You must send a copy of the Personal Development Plan, together with an evidence based report on your progress in achieving the aims set out in that plan, to the HCPC no later than two weeks before any review of this order.
8. You must produce a reflective statement dealing with the impact on patients, colleagues and the wider public interest of the shortcomings found by the Final Hearing panel in your record keeping, safeguarding and supervision, and how you have developed your learning to avoid any repetition.
9. You will be responsible for meeting any and all costs associated with complying with these conditions. Any condition requiring you to provide any information to or obtain the approval of the HCPC is to be met by you. You must send the information required to the offices of the HCPC, marked for the attention of the Director of Fitness to Practise or Head of Case Management.
The Order imposed today will apply from 30 August 2020.
This Order will be reviewed again before its expiry on 28 February 2021.
History of Hearings for Dr Paul F J Fleming
|Outcomes / Status
|Conduct and Competence Committee
|Conditions of Practice