Mrs Daniela Ionescu

Preliminary Matters

1.The Panel was informed that the Registrant had chosen to be present via telephone. The Panel noted that the Registrant did have the capability to attend via video link from a laptop but had considered it too stressful using this format.

2.Given the government recommendations on containing the current COVID-19 pandemic, the HCPTS has decided to suspend all public hearings to protect the health and safety of its registrants and stakeholders. However, to ensure that it can continue to perform its statutory duties of protecting the public and maintaining the integrity of the register, the HCPTS has arranged for this hearing to be conducted by video conference facilities.

Background

3.The Registrant was briefly employed as a registered Hearing Aid Dispenser with Scrivens Opticians and Hearing Care from 19 December 2016 until 1 February 2017. During this probationary period of employment, concerns were raised in relation to her ability to demonstrate the core competencies of a Hearing Aid Dispenser.

Substantive Hearing: 29-30 January 2018

4.The Registrant was referred to the HCPC, and a substantive hearing took place between 29 - 30 January 2018. At that hearing, the Registrant was neither present nor represented. At that time, she had not engaged in the HCPC regulatory process.

5.The substantive hearing Panel (“the Substantive Hearing Panel”) found the facts of the Allegation proven as set out above, that those matters represented a fair sample of her work and concluded that the Registrant’s failings amounted to a lack of competence.

6.The Substantive Hearing Panel also found the Registrant’s fitness to practise was impaired by reason of her lack of competence. It concluded that the Registrant’s lack of competence had fallen seriously short of the Standards of Proficiency expected of a Hearing Aid Dispenser such that her failings put patients at an unwarranted risk of harm and brought the profession into disrepute. That panel further concluded:

“In considering the extent to which the Registrant had or had not demonstrated insight into her failings, the Panel noted that in her interview with her line manager on 1 February 2017 following feedback from Witnesses 1 and 2, the Registrant is reported to have stated: “I realise that I need to do some reading. I have not been working for a while and realise that I need to be a lot more confident before I have the type of meeting I had with [Witness 1].”

The Registrant has not engaged with the proceedings and the Panel has not had the benefit of hearing from her, in person or in writing. As a consequence, the Panel is unable to conclude that the Registrant has demonstrated any meaningful insight into her failings.
The Panel recognised that clinical failings are usually easier to remedy than those, for example, which involve entrenched attitudinal problems. However, it has received no evidence of any steps which the Registrant may have taken since the time of the allegation, to remediate her failings. Accordingly, it had no choice but to conclude that the Registrant’s lack of competence is highly likely to persist. For these reasons, the Panel determined that a finding of personal impairment is required on the ground of public protection.
The Panel then went on to consider whether a finding of impairment is necessary on public interest grounds. In addressing this component of impairment, the Panel had careful regard to the critically important public issues identified by Silber J in the case of Cohen when he said:

“Any approach to the issue of whether .... fitness to practise should be regarded as ‘impaired’ must take account of ‘the need to protect the individual patient, and the collective need to maintain confidence in the profession as well as declaring and upholding proper standards of conduct and behaviour.”
The Panel considered that maintaining competence to undertake safe and effective practice is a fundamental requirement of the profession of Hearing Aid Dispensers and that the public would be concerned to learn of the deficiencies in such fundamental and basic skills and competencies demonstrated by a Registered Hearing Aid Dispenser. The Panel had no doubt that the need to maintain public confidence in the profession, and to declare and uphold proper standards, would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case.
For all the reasons set out above, the Panel determined that the Registrant’s fitness to practise is currently impaired, both on the grounds of public protection and in the public interest.”

7.The Substantive Hearing Panel considered that the Registrant’s failings were basic and fundamental, persisted even after assistance and training and advice had been given, occurred despite close supervision and put patients at unwarranted risk of harm. It concluded that the Registrant had neither demonstrated insight into her failings nor had she remediated her failings and that there was therefore a high risk of her repeating her failings.

8.It concluded that a Conditions of Practice Order would not provide the appropriate level of public protection or uphold the public interest.

9.The Substantive Hearing Panel therefore imposed a Suspension Order for a period of 12 months, to allow the Registrant to reflect on the findings, and consider how she might remediate her failings. It concluded that a reviewing panel might be assisted by the Registrant’s attendance; a reflective piece from the Registrant with regard to the failings found; Evidence from the Registrant as to any steps she may have taken to remediate her failings, including her lack of proficiency in the English language

First Substantive Review Hearing: 21 January 2019

10.The Suspension Order was first reviewed on 21 January 2019. At this hearing, the Registrant attended, but was otherwise unrepresented. That panel (“the First Reviewing Panel”) remained of the view that the Registrant’s lack of competence was serious and involved breaches of her professional standards. It concluded that there has been no evidence of change since the final hearing in January 2018 nor any evidence that the concerns underpinning the Registrant’s impaired fitness to practise had been overcome. The First Reviewing Panel considered the wide-ranging failings identified by the Substantive Hearing Panel and the evidence that the Registrant was unable to follow instructions effectively. It also bore in mind the Registrant’s own evidence that, neither during her six-year career break nor during her period of suspension, had she undertaken any CPD training. The First Reviewing Panel was also concerned that the Registrant stated that she did not accept all of the failings identified by the Substantive Hearing Panel.

11.The First Reviewing Panel concluded that the Registrant’s fitness to practise continued to be impaired. In the absence of any persuasive evidence of remediation, the First Reviewing Panel remained concerned that there was the risk of repetition of the failings identified. The First Reviewing Panel therefore concluded that the Registrant remained liable to put patients at unwarranted risk of harm in the future and that the Registrant remained impaired on public protection grounds.

12.Given the absence of remediation, the First Reviewing Panel also concluded that the need to uphold confidence in the profession and the regulator would be undermined if a finding of impairment were not made. It considered that the Registrant was not safe to practise unrestricted given her current impairment and the public interest required that she should not be in a position to practise unrestricted.

13.The First Reviewing Panel imposed a further 12 months’ Suspension Order, to enable the Registrant to remediate her failings and develop her level of insight. It considered that a future reviewing panel would be assisted by:

•“A diary of continuous learning and reading undertaken by the Registrant in relation to her professional practice, including but not limited to evidence of any continuing professional training or refresher courses;
•Documentary evidence of any continuing professional training or refresher courses undertaken by the Registrant;
•Evidence that she has read the: British Academy of Audiology Guidelines for Audiologists; British Society of Audiology Recommended Procedure Ear Examination; British Society of Audiology Recommended Procedure Pure – tone air-conduction and bone-conduction threshold audiometry with and without masking; British Society of Audiology Recommended Procedure Determination of uncomfortable loudness levels; British Society of Audiology Recommended Procedure Taking an aural impression;
•A written reflective piece addressing each of the core competencies that the Registrant was found to have failed in relation to allegations 1(a)-(e) and by reference to the Standards of Proficiency expected of a registered Hearing Aid Dispenser.
•References and testimonials from the Registrant’s employer, in relation to any paid or voluntary role;
•Evidence that the Registrant has undertaken a course which demonstrates her effective verbal communication in English;
•Evidence that the Registrant has experience in a role as an assistant or technician to a Hearing Care or Audiology professional (where registration is not required) in the NHS or private sector.”

Second Substantive Review Hearing: 7 February 2020

14.The second substantive review hearing was originally listed for 24 January 2020, at which hearing the Registrant did not attend, nor was she represented. The panel at that hearing concluded that the Registrant had been given insufficient notice of the hearing. It therefore adjourned the hearing

15.The Suspension Order was then reviewed on 7 February 2020. At this hearing, the Registrant attended the hearing by telephone, but was not represented. The Registrant accepted that she had not actioned any of the suggestions of the previous panels but that it was her intention to do so, and that she still wished to return to the profession.

16.The Second Reviewing Panel concluded that the Registrant’s fitness to practise continued to be impaired. In the absence of any persuasive evidence of insight and remediation the Second Reviewing Panel remained concerned that there was the risk of repetition of the failings identified. The Second Reviewing Panel therefore concluded that the Registrant remained liable to put patients at unwarranted risk of harm in the future and that the Registrant remained impaired on the personal component of impairment.

17.Given the absence of remediation, the Second Reviewing Panel also concluded that the need to uphold confidence in the profession and the regulator would be undermined if a finding of impairment were not made. It considered that the Registrant was not safe to practise unrestricted given her current impairment and the public interest required that she should not be in a position to practise unrestricted. It therefore concluded that a finding of current impairment was required on the public component of impairment.

18.The Second Reviewing Panel imposed a Suspension Order for further 6 months’ to enable the Registrant to demonstrate that she had address her failings and to develop her level of insight.
 
19.It concluded that whilst it was unable to tie the hands of any future reviewing panel, the option of a Striking-off Order would be available at the next review, which may be of particular relevance if the Registrant were still unable to provide evidence of remediation. It commented that if the required remediation demanded a reduction in the Registrant’s current employment to part time work, as the Registrant had claimed, it would expect that to have been done.

20.This Panel reiterated the guidance which previous panels had identified as steps which the Registrant must undertake to be able to present to a future reviewing panel that she had addressed her failings.

Registrant’s submissions

21.The Registrant provided the Panel in advance with documentation that included a reflective piece of writing and details of her understanding of key core skills and course content. She produced evidence relating to the steps she had taken to improve her English language skills in the form of a letter from Bayswater College which confirmed the Registrant’s enrolment on a part-time English language course in early March 2020, and that before COVID-19 Government Guidelines had been imposed, she had attended for three weeks.

22.The Registrant stated that she had not been working within a medical setting and was currently employed as a receptionist. She intended taking forward her study of English, and whilst she preferred to do this face-to-face, has now reluctantly accepted that she will have to continue her studies using on-line facilities. She confirmed that she had not undertaken any professional training, any professional reading, was not a member of any professional membership body and had no information about the HCPC’s requirements of ‘return to practise course’ nor requirements for Continuing Professional Development (CPD).

23.The Registrant stated that she now understood that the processes within the UK were not only different, but more extensive than that in Romania. The Registrant confirmed that she was no longer registered to work in Romania and that whilst she was working in her home country there was no requirement to undertake any CPD. She confirmed that she has recently gained an understanding of the role and extent of CPD training and requirements in the UK. She confirmed that she has not, excluding the period at Scrivens, been in practice for over 10 years and not undertaken any CPD during this period. She confirmed that in Romania she worked with one form of hearing device and had not appreciated the range of hearing devices available in the UK, most of which required an understanding of the supporting software. The practise in Romania did not require her to undertake service user assessments and counselling.

24.The Registrant appreciated that she perhaps should have identified previously the large gap between her skills and current practice requirements. She stated that she wished to regain her theoretic knowledge. She stated that she understood the need for practice to gain the requisite clinical skills that were required for her safe return to practise. She had not obtained a mentor nor undertaken any shadowing but would make attempts to do so in the future.

HCPC’s Submissions:

25.The HCPC submitted that the Panel’s role is to review the matter on the basis of the evidence available today, and to decide whether the Registrant’s fitness to practise remains impaired, and if so, to decide what the appropriate sanction should be.

26.The HCPC accepted that the evidence placed before the Panel today indicated that the Registrant had taken very limited steps to comply and fulfil the guidance issued by the previous reviewing panels. The HCPC emphasised that the reflective piece of writing was substantially based on reading and replication of standards. The evidence of steps taken to improve her English showed that she had only enrolled in a course in March 2020 and had only, due to COVID-19 restrictions undertaken 3 weeks of that course. No other steps had been taken such as providing a diary or identification of online training courses.

27.The HCPC submitted that the Registrant has not discharged the persuasive burden placed on her by the case of Abrahaem v GMC [2008] EWHC 183 (Admin). It remains the case that:

a. The Registrant has not demonstrated any further level of insight;
b. The Registrant has not provided any evidence of steps taken to remediate her lack of competence;
c. There must therefore remain a high risk of repetition of her lack of competence.

28.The HCPC submitted that in the absence of this information there is continuing impairment and the Panel should make a finding of lack of fitness to practise on both the public and the personal components of its decision.
 
29.The HCPC submitted that had the Registrant not provided any evidence of compliance it may well have requested that a Striking-Off Order be made, however in light of the evidence of some engagement it considered that a further short period of suspension was appropriate and proportionate. The HCPC stated that anything less was not suitable in the absence of any evidence that the Registrant would be safe to return to practice, even under Conditions of Practice, until she has been able to demonstrate effective communication skills and understanding of basic clinical and theoretical areas of practice.

Legal advice

30.The Legal Assessor reminded the Panel that its purpose today was to conduct a comprehensive review to determine if the Registrant is fit to return to unrestricted practice. She referred the Panel to the case of Yussuff v GMC [2018] EWHC 13 (Admin) in relation to the approach to be adopted in relation to this review hearing. She reminded the Panel that its role was not to conduct a rehearing of the allegations nor was it to go behind the previous findings. She advised that in carrying out this assessment, the Panel must exercise its own independent judgment.

31.The Legal Assessor advised that the Panel might find the questions formulated in the case of CHRE v NMC and Grant (2011) EWHC 927 (Admin) of some assistance, albeit slightly modified for these proceedings:

“Does the evidence before the Panel today show that the Registrant’s fitness to practice remains impaired by reason of his misconduct in the sense that he:

a)has in the past acted and/or is liable in the future to act so as to put a service user at unwarranted risk of harm; and/or
b)has in the past brought and/or is liable in the future to bring the profession into disrepute; and/or
c)has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the profession?
d)…..”

32.The Legal Assessor advised the Panel that if it determined that the Registrant’s fitness to practise remained impaired, then the Panel must go on to consider what sanction, if any, should be imposed. The Panel’s powers under Article 30(1) of the Health Professions Order 2001, are

a. Extend the Suspension Order;
b. Make any order it could have made at the time of the original Order being imposed;
c. Or replace the Suspension with a Conditions of Practice Order, with which the Registrant must comply if he resumes practice.

33.She also advised the Panel that it should bear in mind the principles of fairness and proportionality and have regard to the Sanctions Policy document issued by the HCPTS. She reminded the Panel that any order that it makes under Article 30 should not be punitive in purpose, and that it should be the least restrictive order that would suffice to protect the public and/or would otherwise be in the public interest.

34.The Legal Assessor reminded the Panel of the terms of Article 29(6) of the Health Professions Order 2001 which states:

“A striking-off order may not be made in respect of an allegation of the kind mentioned in Article 22(1)(a)(ii), 'lack of competence' or (iv), 'health' unless the person concerned has been continuously suspended, or subject to a conditions of practice order, for a period of no less than two years immediately preceding the date of the decision of the Committee to make such an order.”

35.The Legal Assessor reminded the Panel that as the Registrant has now been continuously suspended for over two years, the provisions of Article 29(6) of the Health Professions Order 2001 apply, namely, that this Panel now has the option to strike the Registrant’s name from the register.

Panel’s decision

36.The Panel accepted the advice of the Legal Assessor. The Panel has had regard to the HCPTS’s Practice Note on Fitness to Practise Impairment and the terms of the Sanction Policy.

37.The Panel first considered whether the Registrant’s fitness to practise is currently impaired. The Panel took into consideration all the documentation before it, and the submissions of the parties. The Panel considered that this review required the Registrant to demonstrate both developed insight and remediation of her failings for her to be considered suitable for return to unrestricted practice. This type of review placed a persuasive burden on the Registrant to show that she has complied and fulfilled her responsibility to show she is safe to return to practice.

38.There is fresh evidence of engagement by the Registrant in the regulatory process. There is some evidence of fresh insight into the range and nature of her practice failings. However, this is limited in nature and demonstrates only a start of what will be a considerable programme of re-education, acquisition of skills and personal development.  

39.There is no evidence of remediation to support the Panel in allowing the Registrant to return to safe practise at this time. The Registrant has today freely admitted the extent of her previous failings and lack of understanding of the areas of concern. The Panel has therefore concluded that there was no information before it that could lead it to conclude that there was not an ongoing need for a restriction on the Registrant’s practice. In those circumstances, it concluded that public confidence in the profession and in the regulatory process would be undermined if the Registrant were able to practise without restriction.

40.In the light of all the above, the Panel determined that the Registrant’s fitness to practise also remains impaired on the public component.

41.The Panel then went on to consider what the appropriate and proportionate sanction should be, starting with the least restrictive. It bore in mind that the purpose of a sanction was not to be punitive, although a sanction may have that effect.

42.The Panel also bore in mind that its over-arching objective is:

• to protect, promote and maintain the health, safety and wellbeing of the public;
• to promote and maintain public confidence in the profession; and
• to promote and maintain proper professional standards and conduct for members of the profession.

43.The Panel first considered taking no action but was satisfied that the Registrant’s failings were so serious that the public interest considerations could not be met by such an outcome. The Panel was not satisfied that there would be no risk to the public, or to public confidence in the profession by taking no action.

44.Given the Panel’s findings, it was also not satisfied that mediation was an appropriate sanction given that in the particular circumstances of this case make such an outcome irrelevant.

45.The Panel next considered whether to impose a Caution Order in light of guidance within the Sanctions Policy. It concluded such an order would not be sufficient to protect the public, nor would either it be in the public interest given that the Registrant’s failings were not minor. Such an order would not restrict the Registrant’s practice and would therefore not adequately protect the public or safeguard the public interest.

46.The Panel next considered whether to impose a Conditions of Practice Order. It concluded that it would neither be appropriate nor proportionate given the nature of the lack of competence found proved and the lack of any evidence that the Registrant has taken appropriate steps to remedy those failings. The Panel concluded that it could not formulate appropriate conditions to address the Registrant’s failings other than those which would in practice be a suspension by another means.

47.The Panel next considered extending the existing Suspension Order. The Panel noted that the Registrant has only partially engaged in the regulatory process to date and has not availed herself of the opportunity of demonstrating to this Panel, that she is able return to practice.  There was limited evidence before the Panel that the Registrant had developed insight into her failings. The Panel considered that this insight into the extent of her failings could be further developed by periods of study and retraining. The Panel accepted that there was a willingness on the Registrant’s part to seek avenues by which she could regain her skills and knowledge and extend them comply with UK standards and practice. In concluding that a further period of suspension is appropriate rather than taking the step of imposing a striking off order the Registrant should be in no doubt that in this Panel’s view she should be able to demonstrate before the end of this further order a sustained, focused and evidence based programme of learning, practice and development. This Panel has set out below the matters which a future Panel may wish to see before it. Whilst this Panel cannot bind the decision of a future panel, what it has identified is, in this Panel’s view, the bare minimum required and the Registrant may wish to take steps demonstrate more of her skills and knowledge, particularly in the area of communications, rather than less in this regard.

48.To assess whether the decision for a short further period of suspension was both appropriate and proportionate the Panel gave consideration to whether a striking-off order was warranted in this case. In this regard the Panel noted that the Registrant has been out of practise for over 10 years, engaged only a limited way with the process and has only so late in the day produced evidence of her willingness to remain part of her profession. The Panel has concluded that the Registrant has, at this time, provided sufficient indication of her ability and willingness to remediate that it would be disproportionate to strike her off the Register.

49.The Panel has considered carefully the length of time this further period of suspension should be for. The period has to be sufficient for the Registrant to be able to provide a future reviewing panel with evidence of significant progress with her programme of retraining and development. It has concluded that 6 months is sufficient in all the circumstances of this case. Any more time may prove a disincentive to the Registrant to take forward her newly acquired confidence, focus and energy. The Registrant should be aware that a future reviewing panel will have the same powers as this panel which will include extending or replacing an order. This means that if the Registrant is able to provide evidence of sustained effort in improving her communication skills and undertaking appropriate courses, including those relating CPD, it would support that future panel imposing a different level of restriction on her practice. Further, if the Registrant is able to amass all the required evidence necessary to support her return immediately to safe practice she may ask for an early review under the provisions of Article 30(2). Conversely, if the Registrant takes no further action to remediate her failings the option of removing her from the register remains a possibility.

50.The Panel makes the Order for a further period of suspension in the interests of service users and the wider public interest. This Panel repeats the suggestions of a previous reviewing panel that a subsequent reviewing panel might be assisted by the following:

•A diary of continuous learning and reading undertaken by the Registrant in relation to her professional practice, including but not limited to evidence of any continuing professional training or refresher courses;

•Documentary evidence of any continuing professional training or refresher courses undertaken by the Registrant;

•Evidence that she has read the: British Academy of Audiology Guidelines for Audiologists; British Society of Audiology Recommended Procedure Ear Examination; British Society of Audiology Recommended Procedure Pure – tone air-conduction and bone-conduction threshold audiometry with and without masking; British Society of Audiology Recommended Procedure Determination of uncomfortable loudness levels; British Society of Audiology Recommended Procedure Taking an aural impression;

•A written reflective piece addressing each of the core competencies that the Registrant was found to have failed in in relation to allegations 1(a)-(e) and by reference to the Standards of Proficiency expected of a registered Hearing Aid Dispenser.

•References and testimonials from the Registrant’s employer, in relation to any paid or voluntary role;

•Evidence that the Registrant has undertaken a course which demonstrates her effective verbal communication in English;

•Evidence that the Registrant has experience in a role as an assistant or technician to a Hearing Care or Audiology professional (where registration is not required) in the NHS or private sector”.

The Registrar is directed to further suspend the name of Mrs Daniela Ionescu from the Hearing Aid Dispenser part of the HCPC register for a further period of 6 months upon the expiry of the current order.

The order imposed today will apply from 27 August 2020.
 
This order will be reviewed again before its expiry on 27 January 2021.

History of Hearings for Mrs Daniela Ionescu