Mr Stephen R Lilley

Profession: Chiropodist / podiatrist

Registration Number: CH14740

Hearing Type: Consent Order Hearing

Date and Time of hearing: 10:00 01/05/2020 End: 17:00 01/05/2020

Location: Health and Care Professions Tribunal Service, 405 Kennington Road, London, SE11 4PT

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

Between April 2016 and November 2016, whilst employed as a Chiropidist/Podiatrist at Leicestershire Partnership NHS Trust:

1. On or around 14 April 2016, during an appointment with Patient A you did not:
a. Assess and/or complete an adequate assessment of the right foot injury reported by Patient A.
b. Complete adequate case notes.
c. Place Patient A back on the high risk review list for high risk diabetic patients.
d. Refer Patient A to a specialist foot clinic, following the appointment.

2. You did not undertake an adequate assessment and/or record an adequate assessment in respect of the following patients:
a. Patient 2
b. Patient 3
c. Patient 7
d. Patient 9
e. Patient 15
f. Patient 19
g. Patient 20
h. Patient 25
i Patient 26
j. Patient 28
k. Patient 36
l. Patient 40
m. Patient 43
n. Patient 48
o. Patient 49
p. Patient 54
q. Patient 55
r. Patient 57
s. Patient 58
t. Patient 59
u. Patient 60
v. Patient 63
w. Patient 64
x. Patient 65
y. Patient 68
z. Patient 69

3. You did not record and/or demonstrate adequate clinical reasoning and/or decision making for the diagnoses made and/or treatment provided in respect of the following patients:
a. Patient 2
b. Patient 4
c. Patient 6
d. Patient 8
e. Patient 9
f. Patient 11
g. Patient 12
h. Patient 13
i. Patient 15
j. Patient 16
k Patient 19
l. Patient 20
m. Patient 23
n. Patient 25
o. Patient 27
p. Patient 36
q. Patient 37
r. Patient 40
s. Patient 43
t. Patient 45
u. Patient 46
v. Patient 47
w. Patient 48
x. Patient 49
y. Patient 54
z. Patient 55
aa. Patient 57
bb. Patient 58
cc. Patient 59
dd. Patient 63
ee. Patient 64
ff. Patient 65
gg. Patient 73

4. You did not complete and/or record an adequate treatment plan and/or any
treatment plan in respect of the following patients:
a. Patient 7
b. Patient 4
c. Patient 13
d. Patient 15
e. Patient 21
f. Patient 28
g. Patient 33
h. Patient 38
i. Patient 51
j. Patient 56
k. Patient 57
l. Patient 58
m. Patient 65
n. Patient 66
o. Patient 68

5. You did not make an onward referral or you did not record making an onward referral in respect of the following patients;
a. Patient 21
b. Patient 22
c. Patient 32
d. Patient 36
e. Patient 38
f. Patient 46
g. Patient 57
h. Patient 62
i. Patient 83

6. You did not complete adequate and/or any case records in respect of the following patients:
a. Patient 57
b. Patient 58
c. Patient 59
d. Patient 64
e. Patient 66
f. Patient 75

7. Each of your actions as described in paragraphs 1 to 6 amounts to a lack of competence and/or misconduct.

8. By reason of your lack of competence and/or misconduct your fitness to practise is impaired.

Finding

Preliminary Matters

Application for hearing in private

1. Ms Sheridan, on behalf of the HCPC, and Mr Bousfield jointly applied for any parts of the hearing which concerned the private life of the Registrant to be dealt with in private.  

2. The Panel received and accepted the advice of the Legal Assessor.  The Panel referred to Rule 10(1)(a) of the HCPC (Conduct and Competence Committee) (Procedure) Rules 2003 and the HCPTS Practice Note, Private Hearings. 

3. The Panel was mindful that the default position is that HCPC hearings take place in public, in the interests of open justice and the public interest in regulation.  The Panel was satisfied that in this case it may be necessary for matters relating to the Registrant’s private life or health to be discussed.  It was satisfied there was good reason to depart from the usual position in order to protect the private life of the Registrant, as permitted by Rule 10(1)(a).  The Panel considered, however, that it would be possible to deal only with the relevant parts in private session and that the remainder of this hearing could take place in public. 

Documents

4. The Panel received a Consent Bundle (numbered 1-188) and a Final Hearing Bundle (numbered 1-D1431) from the HCPC.
 
5. The Registrant submitted a reflective piece, a report and patient reviews prepared by his current employer /supervisor, Ms H, Personal Development Plans for January and April 2020 and certificates relating to Continuing Professional Development (CPD) courses.

Amendment of draft Consent Order
 
6. During the hearing it was noted that there was a minor typographical error in the draft Consent Order.  This was the omission of the word “or” before the phrase “appropriate statutory regulator” in Condition 1.  With the parties’ agreement, the Panel has made this amendment in the Consent Order.
 
Background

7. The Registrant is an HCPC registered Chiropodist/Podiatrist. From 2000 until March 2017, he was employed by Leicestershire Partnership NHS Trust (“the Trust”).  From 2014, he worked as a Band 6 Associate Podiatrist. 

8. In 2016, a concern regarding Patient A came to the attention of the Trust. It was identified that during an appointment with Patient A, the Registrant failed adequately to assess and/or complete adequate notes of an assessment of Patient A’s right foot.  It also appeared that he had failed to refer Patient A to a specialist foot clinic. Patient A had attended the Registrant as a patient on the Trust’s high-risk review list, as she was a diabetic patient, and she was not re-added to this list by the Registrant. 

9. The Trust’s investigation into Patient A’s case established that there were a number of deficiencies in the Registrant’s assessment and record-keeping in other patient cases.  It was alleged that on approximately 26 occasions, he had not undertaken and/or recorded adequate assessments.  On approximately 33 occasions, he had not recorded and/or demonstrated adequate clinical reasoning and/or decision making in respect of the diagnoses given to patients and/or the treatment plans prescribed to those patients.  On approximately 15 occasions, the Registrant had not completed and/or recorded an adequate treatment plan or any treatment plan for patients.  On approximately 9 occasions, he had not made an onward referral or did not record one.  On approximately 6 occasions he did not complete adequate and/or any case records for patients.
 
10. The Trust subsequently placed the Registrant on its Performance Management Framework process. The Registrant submitted a grievance during this period.  The Trust had decided to progress to Stage 4 of the formal process.  The Registrant resigned from the Trust in March 2017, before the Trust’s investigating officer had finalised her investigation report. The Trust referred its concerns regarding the Registrant to the HCPC on 11 January 2017.

HCPC background 

11. In March 2017, an Interim Conditions of Practice Order was imposed on the Registrant’s registration.  This was revoked on 8 August 2018.

12. On 1 October 2018, a panel of the HCPC’s Investigating Committee found a case for the Registrant to answer and referred the allegation (as set out above) to the Conduct and Competence Committee. The Registrant had admitted the allegation in his representations to the Investigating Committee. Subsequently, the HCPC discussed with the Registrant’s legal representatives that his case may be suitable for disposal by an agreed order, in accordance with the HCPC’s consent order process. The Registrant made full admissions and it was initially agreed that the appropriate order was a Conditions of Practice Order for a period of 18 months.

13. The Registrant’s case came before a Conduct and Competence Committee Panel on 14 June 2019 to consider the proposed Consent Order. Before the Panel was seized of the case it was noted as a preliminary issue that the HCPC had not specified whether the Registrant’s fitness to practise was impaired on the ground of misconduct, or on the ground of lack of competence.  The hearing on 14 June 2019 therefore did not proceed. 

14. The HCPC and the Registrant have since reached agreement that the alleged and admitted ground of impairment is lack of competence.  Given the time period which has elapsed since the original hearing on 14 June 2019, the HCPC has now accepted that the appropriate duration of the proposed Conditions of Practice Order is 12 months.

Submissions

15. Ms Sheridan, on behalf of the HCPC, set out the background. She submitted that the proposed Consent Order for the imposition of a Conditions of Practice Order in respect of the Registrant’s registration for a period of 12 months would secure the appropriate level of public protection and would not be detrimental to the wider public interest.

16. Mr Bousfield confirmed that the Registrant admitted the allegation and that his fitness to practise is impaired by reason of lack of competence. He referred the Panel to the documents submitted on behalf of the Registrant.  He referred to circumstances, both in relation to his employment with the Trust and his personal circumstances, which the Registrant believes affected his competence during his employment with the Trust.  Mr Bousfield submitted that the Panel could be reassured the Registrant has gained insight and remedied his past failings. He reminded the Panel that the Registrant has now been back in practice since March 2017 without further incident. 

17. Mr Bousfield confirmed that the Registrant consented to the Conditions of Practice Order in the terms submitted to the Panel being made for a duration of 12 months. 

Decision

18. The Panel accepted the advice of the Legal Assessor.  It applied the guidance in the HCPTS Practice Note “Disposal of Cases by Consent” (March 2018) and referred to the HCPC Sanctions Policy (March 2019).

19. The Panel was aware that it was not obliged to accept that the Consent Order agreed between the Registrant and the HCPC is the appropriate disposal of the case: it could reject the Consent Order and direct that the matter proceeds to a full hearing, before a different panel of the Conduct and Competence Committee.

20. The Panel noted that neither the HCPC nor the Panel should agree to resolve a case by consent unless they are satisfied that (a) the appropriate level of public protection is being secured; and (b), doing so would not be detrimental to the wider public interest.

21. The Panel further noted that the HCPC will only consider resolving cases by consent where:

a) the Investigating Committee had found that there is case to answer;
b) the Registrant has admitted the allegation in full;
c) any remedial action agreed between the Registrant and the HCPC is consistent with the expected outcome if the case were to proceed to a contested hearing.

22. The Registrant admits the allegation in full.  He admits that his fitness to practice is currently impaired by reason of lack of competence.  The HCPC and the Registrant propose that the Registrant’s case should be concluded with a Conditions of Practice Order for a period of 12 months.  A draft Order has been presented for the Panel to consider. 

23. In considering the matter, the Panel carefully reviewed the Consent Bundle and the Final Hearing Bundle. The latter contained the evidence which would be presented by the HCPC at a contested final hearing, were the case proceeding to that stage.  The Hearing Bundle contained witness statements obtained from the HCPC’s witnesses and copies of the records of the patients referred to in the allegation.  It also included the Registrant’s written representations to the Investigating Committee in October 2018, in which he admitted the allegations.

24. The Panel also carefully reviewed the recent documentation submitted by the Registrant.  This included:

a. the Registrant’s document entitled “Reflections on Previous and Current Podiatry Practice” dated April 2020;
b. a report dated 14 April 2020 from Ms H, the owner of the podiatry practice where the Registrant has been employed since March 2017 and who was his supervisor appointed under the Interim Conditions of Practice Order;
c. Personal Development Plans;
d. Patient reviews undertaken by Ms H with the Registrant in January, February and March 2020;
e. a certificate relating to a record-keeping course undertaken by the Registrant dated 29 March 2017 and several certificates relating to on- line CPD provided by the Society of Chiropodists and Podiatrists.

25. The Panel noted that the Registrant feels that he experienced a difficult working environment in his later years of employment at the Trust.  At this time, he states that he also had a number of personal difficulties. He has described that, since starting his new employment at Ms H’s podiatry practice in March 2017, he feels professionally supported by Ms H, has regained his confidence and his enthusiasm for his profession. He told the Panel that his record-keeping standards are now better than they have ever been.

26. The Panel noted that the Registrant made early full admissions to the HCPC allegations at the stage of consideration by the Investigating Committee.  He has engaged with the HCPC process.  He complied with the Interim Conditions of Practice Order when in operation. In the period since March 2017, he has been in practice at Ms H’s practice without further incident.  During this time, he has been working on remedying the deficiencies in his practice. 

27. The Registrant and Ms H have told the Panel that the Registrant has continued to be supervised and supported by Ms H since the Interim Order was revoked in August 2018.  The Panel noted the up to date report from Ms H (dated 14 April 2020) in which she confirms that the Registrant is now “diligent and meticulous” in his record-keeping and that he “demonstrates clinical reasoning skills at a high level”.  
 
28. The Panel was satisfied that the Registrant has reflected on the issues identified in the allegation and is developing insight. The Panel was satisfied that there is a low risk of repetition of the past lack of competence. 
 
29. The Panel was mindful that it must take a proportionate approach when considering the proposed sanction by both parties, which means imposing the lowest order which protects the public, maintains public confidence in the profession and maintains professional standards.  In reaching its decision, the Panel took into account the Registrant’s acceptance that his fitness to practise is currently impaired. The Panel accepted that the Registrant’s lack of competence is capable of being remedied and that he has already taken considerable steps towards this. 

30. The Panel was of the view that to take no action or issue a Caution would be insufficient, given the seriousness and scope of the allegation. The Panel concluded that a Conditions of Practice Order would be an appropriate means by which to address the remaining concerns in this case. An order of suspension would be disproportionate and would remove from practice a committed and capable Podiatrist.

31. The Panel was satisfied that the agreed conditions are appropriate.  The Panel has confidence that the Registrant will comply with them, as he did with the interim conditions.
 
32. In respect of the duration of the conditions, a period of 12 months will enable the Registrant to continue his reflection and remediation, whilst ensuring that the public remains protected.  The Panel was mindful that the HCPC had recently revised its position to propose a duration of 12 rather than 18 months in the light of the time which has elapsed since the adjourned hearing in June 2019.  The Panel accepted that this was the appropriate and proportionate duration.  

33. The Panel carefully considered whether the approval of the Consent Order would be detrimental to the wider public interest and was satisfied that it would not.  The Panel was satisfied that the proposed Conditions of Practice Order will provide adequate public protection and is sufficient to maintain confidence in the profession and the regulatory process. The order will be reviewed before its expiry which will enable a future Panel to assess the Registrant’s compliance with the conditions and to consider the Registrant’s current fitness to practise.

Order

That the Registrar be directed to annotate the Register to show that, for a period of 12 months from the date that this Order comes into effect (the Operative Date), you, Mr Stephen R Lilley, must comply with the following conditions of practice:

1. You must place yourself and remain under the supervision of a supervisor registered by the HCPC or appropriate statutory regulator and supply details of your supervisor to the HCPC within 14 days of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

2. You must work with your supervisor to formulate a Personal Development Plan designed to address the deficiencies in the following areas of your practice:

a. Your record-keeping; in particular, the documentation of up-to-date histories, appropriate assessment, treatment planning and review of all patients seen.
b. Your clinical reasoning and decision-making skills.

3. Within three months of the Operative Date you must forward a copy of your Personal Development Plan to the HCPC.

4. You must meet with your supervisor on a monthly basis to consider your progress towards achieving the aims set out in your Personal Development Plan.

5. You must allow your supervisor to provide information to the HCPC about your progress towards achieving the aims set out in your Personal Development Plan.

6. You must seek a report from your supervisor for consideration by the HCPC prior to any review hearing.

7. You must promptly inform the HCPC if you cease to be employed by your current employer or take up any other or further employment.

8. You must promptly inform the HCPC of any disciplinary proceedings taken against you by your employer.

9. 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).

10. You will be responsible for meeting any and all costs associated with complying with these conditions.

Notes

No notes available

Hearing History

History of Hearings for Mr Stephen R Lilley

Date Panel Hearing type Outcomes / Status
01/05/2020 Conduct and Competence Committee Consent Order Hearing Conditions of Practice
14/06/2019 Conduct and Competence Committee Consent Order Hearing Adjourned
11/05/2018 Investigating committee Interim Order Review Interim Conditions of Practice
16/02/2018 Investigating committee Interim Order Review Interim Conditions of Practice
23/11/2017 Investigating committee Interim Order Review Interim Conditions of Practice
25/08/2017 Investigating committee Interim Order Review Interim Conditions of Practice
09/03/2017 Investigating committee Interim Order Application Interim Conditions of Practice