Miss Deborah J Watson

Profession: Occupational therapist

Registration Number: OT20331

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 30/11/2020 End: 17:00 30/11/2020

Location: This hearing is being held virtually .

Panel: Conduct and Competence Committee
Outcome: Suspended

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Allegation

Whilst registered as an Occupational Therapist you:

1. On 16 July 2015:

a) In relation to Service User A:

i) Left her in the therapy suite unaccompanied; and/or
ii) Did not review the observation and engagement care plan for Service User A; and/or
iii) Did not enquire as to what observation levels Service User A was on.

b) In relation to Service User B:

i) Allowed him to leave the therapy suite without escort; and/or
ii) Did not check the observation and escort requirements of Service User B with ward staff; and/or
iii) Did not follow the observation and escort requirements of Service User B.

c) In relation to Service User C:

i) Did not check the observation and escort requirements of Service User C with ward staff; and/or
ii) Did not follow the observation and escort requirements of Service User C.

2. Between April 2014 and October 2014 did not seek clinical supervision.

3. On 19 November 2014, in respect of a GP referral of Service User E did not:

a) Follow up the referral; and/or
b) Prepare a risk assessment; and/or
c) Prepare a risk management plan.

4. The Matters set out in paragraphs 1 – 3 constitute misconduct and/or lack of competence.

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

Finding

Preliminary Matters

Private

1. The Panel determined of its own volition that it may be appropriate to hear parts of the hearing in private. This is because parts of the papers revealed matters that were relevant to the private life of the Registrant. The Panel offered parties the opportunity to make representations but none were made. Having accepted the advice of the Legal Assessor, the Panel determined that parts of the hearing would be held in private session when matters relating to the health of the Registrant were raised. The Panel Chair invited parties to highlight when such matters were to be raised to assist.

Background

2. The Registrant is an Occupational Therapist registered with the HCPC. During the period referred to in the Allegation, she was employed as a Band 6 Care Co-Ordinator Occupational Therapist by Leeds and York Partnership NHS Foundation Trust. From 1 October 2016, the Registrant was employed by Tees, Esk and Wear Valleys NHS Trust (“the Trust”) in a community setting.

3. Concerns arose in respect of the Registrant’s practice and a Performance Improvement Plan was implemented. The Registrant was moved to a role in a mental health ward, where she was subject to supervision. A further concern arose when the Registrant left a service user unaccompanied in a therapy suite. An investigation was undertaken, as a result of which further concerns about the Registrant’s practice were identified.

4. The Registrant referred herself to the HCPC on 20 October 2015. The Trust conducted a disciplinary hearing in March 2016 which resulted in the Registrant’s dismissal for gross misconduct.

5. The substantive HCPC Conduct and Competence Committee hearing took place on 11-13 December 2017. The Panel at that hearing found all the factual particulars of the Allegation proved and that the facts amounted to misconduct. The Panel found the Registrant’s fitness to practise impaired in relation to both the personal and public components of current impairment. The Panel determined to impose a Suspension Order for a period of 12 months.

1st Review: 7 December 2018

6. The Suspension Order was reviewed by a panel of the Conduct and Competence Committee at a hearing, which the Registrant attended and at which she was represented, on 7 December 2018. The panel considered the guidance given by the substantive hearing panel as to information which a future review panel was likely to find helpful.

7. The Registrant presented information about actions she had taken since the Suspension Order was imposed. The first review panel considered information presented by the Registrant and heard oral evidence from her. She said she did not feel confident to return to her role and herself considered that her fitness to practise remained impaired.

8. The first review panel stated that it was impressed by the Registrant’s reflective statements and the development of her insight into the effect and consequences of her past failures in care. However, the review panel stated that it was not satisfied that the Registrant had demonstrated that she had applied her knowledge of theory to the specific failings identified at the substantive hearing. She admitted that there remained gaps in her knowledge and skills. In the view of the review panel, these gave rise to
a risk of repetition which could potentially pose a risk to service users and undermine public confidence in the profession.

9. The Panel found that the Registrant’s fitness to practise remained impaired and determined to extend the Suspension Order for a further 12 months. This would allow the Registrant to demonstrate at the next review hearing that she had made sufficient progress in her professional development to return to practice as an Occupational Therapist.

2nd Review: 12 December 2019

10. The Suspension Order was reviewed by a panel of the Conduct and Competence Committee at a hearing, which the Registrant attended and at which she was represented, by Mr Oestreicher. The Panel heard from the Registrant. In closing submissions, Mr Oestreicher said that whilst the Registrant accepted that her fitness to practise remained impaired and he acknowledged that the Panel may decide that suspension continued to be necessary, he would ask the Panel to consider whether conditions of practice could be formulated which would allow her to work as an Occupational Therapist.

11. The Panel did find that the Registrant’s fitness to practise remained impaired. It indicated that it hoped to hear how the Registrant coped with making progress going forward by the time of the next review of the order. It determined to extend the Suspension Order for a further 12 months.

Decision

12. The Registrant gave evidence under affirmation. The Panel found that the Registrant was a credible and honest witness, in making every effort to answer questions put to her. While she sometimes struggled to respond immediately to questions, she did provide relevant information, and appeared to be forthcoming in so doing. The Registrant told the Panel that she believed her fitness to practise is currently impaired and would benefit from a further period of suspension. She indicated that she would ask for an early review if she made good progress.

13. The Panel took into account the submissions of the parties.

14. Ms Sampson submitted that the Registrant is by her own admission, still impaired. She said that the Registrant had made some efforts to remedy her misconduct, but some difficult personal circumstances and the global pandemic were both recognised as having had some impact upon her efforts. Nonetheless, the efforts of the Registrant were insufficient to address her impairment and she submitted that the Registrant had failed to discharge the persuasive burden to indicate that she was no longer impaired. Ms Sampson also referenced to the Panel the Indicative Sanctions Policy (“ISP”), and indicated that its decision making should take into account the principle of proportionality.

15. The Registrant’s representative submitted that the Registrant was aware that it was not feasible to continue suspension indefinitely. He said that the Registrant is under no illusion that more significant progress needed to be achieved by the time of the next review. He described the situation in which the Registrant found herself at as the “last-chance saloon,” in apparent acknowledgement of the fact that there have now been three consecutive years of suspension orders.

16. The Panel accepted the advice of the Legal Assessor. The Panel was referred to the HCPTS Practice Notes “Finding That Fitness to Practise is ‘Impaired’” and “Reviews of Article 30 Sanction Orders”, and to the HCPC Sanctions Policy. The Legal Assessor reminded the Panel that it should first consider whether the Registrant’s fitness to practise remains currently impaired. She reminded the Panel of its powers at a mandatory review under Article 30(1) of the Health Professions Order if current impairment is found, and that it should impose the least restrictive order which appropriately protects the public and the public interest.

17. The Panel carefully considered the information presented by the Registrant, which included a detailed reflective statement. The Panel acknowledged the work the Registrant had undertaken and that she had made some progress. The Panel considered that the Registrant’s misconduct, although not persistent, was serious. This misconduct was capable of remediation but this remediation has not been completed. While the Registrant’s responses showed that she had continued to develop insight into her past failings, the Panel noted that the Registrant had not been able fully to remediate her misconduct to date. A combination of a global pandemic and personal difficulties had impacted this, but the Panel found that there were steps which the Registrant might have taken, such as making applications for placements before the pandemic occurred. In this regard the Panel asked the Registrant if it was the review hearing which had in fact focused her mind; the Registrant agreed that this in part, was the case. The Panel was also concerned on the heavy reliance placed by the Registrant at the hearing on her reading of a limited number of textbooks as partial evidence that the Registrant was making a determined effort to remediate. Further, the Panel was aware that the Registrant had proved unable to continue with a voluntary
befriending role due to health issues. This involved only one session a week. While it commended the Registrant for her voluntary work and noted that an excellent reference from York City Council had been produced, praising the Registrant for the diplomatic way she had dealt with a safeguarding issue, it considered that this was significantly different from a professional OT role and had been carried out for a limited time and for only one session per week.

18. The Registrant told the Panel that she believes there are gaps in her skills and knowledge which she believes she needs to address. She indicated that she was not ready to return to practice at this time, although she indicated that she felt more optimistic about a return to work now than she had previously been.

19. Having taken into account all the information before it, the Panel considered that there remains a risk to the public. While the Registrant’s admissions about her deficiencies reflect insight, they also indicate current impairment. It concluded that members of the public would be concerned if the Registrant, who has admitted gaps in her skills and knowledge which pose a potential risk to the public, and who accepts that she remains impaired, were found not be to impaired. Public confidence in the profession and the regulatory process would be undermined. The Panel therefore concluded that the Registrant’s fitness to practise is impaired on the grounds of public protection and the wider public interest.

20. The Panel considered the available sanctions and referred to the HCPC Sanctions Policy. It applied the principle of proportionality and carefully considered the sanctions in ascending order of seriousness.

21. The Panel considered that it would not be appropriate to impose no order or a Caution Order because the public would not thereby be protected and the wider public interest would not be adequately addressed.

22. The Panel took into account Mr Oestreicher’s submission relating to conditions and therefore carefully considered whether it could formulate a Conditions of Practice Order. However, the Panel concluded that no conditions could be formulated which would not be tantamount to suspension. Further, a conditions of Practice Order would not be appropriate or workable as the Registrant has acknowledged gaps in her knowledge and skills which may have been present at an earlier stage, but of which she may not have been aware. The Panel considered that conditions would not be adequate until these fundamental gaps in her knowledge have been addressed, because these gaps may give rise to risk.

23. The Panel concluded that a further period of suspension of 12 months would be appropriate and proportionate to address public protection and the wider public interest issues. The Panel considered that a shorter period would not realistically allow the Registrant sufficient time to remediate, particularly in the current climate. The Panel noted there is an option for her to apply for an early review of the suspension under Article 30(2).

24. The Panel acknowledges that the Registrant believes she can return to practice and has a plan for how to address her skills and knowledge gaps, and put theory into practice. It encourages her to actively initiate and follow all parts of this plan if she is able, rather than simply rely upon reading relevant material.

25. The Panel did consider whether or not to strike-off the name of the Registrant from the Register. This was considered because five years have elapsed since the misconduct which brought the Registrant before the Substantive Tribunal in 2017. The Panel took particular note of the global pandemic and how it has impacted many people in myriad ways. Given that the Registrant had engaged in the process and presented herself as someone who was determined to return to practice, the Panel was persuaded that a further period of suspension was proportionate in all the circumstances. It hoped that the Registrant would make good use of this further period to address her skills and knowledge gap and consider O/T placements in which to embed these.

26. Whilst this Panel cannot bind any future reviewing panel, such a panel is likely to be assisted by:

• The Registrant’s attendance at the review hearing;
• Evidence that she had undertaken training to address gaps in her knowledge and skills;
• Evidence of the Registrant’s work since the first review hearing, whether paid or unpaid, in a role related to that in which her knowledge and skills as an Occupational Therapist have been deployed, together with any references or testimonials in relation to such work - especially in relation to her ability to assess and respond to risk;
• Evidence of her Continuing Professional Development (“CPD”) and that she has kept her knowledge of Occupational Therapy up-to-date.

Order

ORDER: The Registrar is directed to suspend the registration of Miss Deborah J Watson for a further period of 12 months upon expiry of the existing Order.

Notes

The Order imposed today will apply from 10 January 2021.

Hearing History

History of Hearings for Miss Deborah J Watson

Date Panel Hearing type Outcomes / Status
30/11/2020 Conduct and Competence Committee Review Hearing Suspended
12/12/2019 Conduct and Competence Committee Review Hearing Suspended
07/12/2018 Conduct and Competence Committee Review Hearing Suspended
11/12/2017 Conduct and Competence Committee Final Hearing Suspended