Mr Stephen G Morgan

Profession: Occupational therapist

Registration Number: OT35127

Hearing Type: Review Hearing

Date and Time of hearing: 10:00 30/09/2020 End: 17:00 30/09/2020

Location: This hearing is being held virtually.

Panel: Conduct and Competence Committee
Outcome: Conditions of Practice

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Allegation

The following Allegation was found proved by a panel of the Conduct and Competence Committee at a Substantive Hearing which took place on 26 - 28 November 2018 and 25 March 2019.

Whilst registered as an Occupational Therapist and during the course of your employment at Cambridgeshire and Peterborough NHS Foundation Trust:

1. In relation to Service User A you completed a home visit on or around 28 October 2016 and:

a. Did not make a record of the visit

b. Did not request the required equipment and / or adaptations until around 1 December 2016

2. [Not proved]

3. In relation to Service User C on or around 27 September 2016 you did not demonstrate:

a. Collaborative working in that you misinterpreted what your colleague said during a meeting

b. Effective clinical reasoning in relation to the kitchen assessment

4. In relation to Service User D you did not ensure that the required equipment was available in time for the scheduled discharge on 21 September 2016

5. In relation to Service User E you:

a. Did not complete and/or record a discharge assessment summary

b. Did not arrange follow-up care following Service User E’s discharge on or around 4 August 2016

6. In relation to Service User F you did not write a report in relation to the access visit completed on or around 31 October 2016

7. In relation to Service User G you completed a home visit on or around 9 November 2016 and you did not record:

a. A home visit report

b. A transfer summary

8. In relation to Service User H you completed an access visit on or around 20 October 2016 and did not complete an access visit report

9. In relation to Service User I you called Service User I’s son on or around 13 October 2016 regarding a home visit and you:

a. Did not record a summary of the visit

b. Did not record a report of the visit

10. In relation to Service User J you did not record a home visit you completed on or around 16 December 2016

11. In relation to Service User K you:

a. On or around 15 November 2016 did not order the equipment which you had identified as required for Service User K’s discharge in a timely manner

b. Did not record the equipment order in Service User K’s notes

12. In relation to Service User L in approximately February 2017 you did not facilitate the discharge in that you:

a. Did not successfully contact the housing team

b. Did not arrange an access visit

c. Did not arrange the required equipment

13. In relation to Service User N in approximately April 2015 you did not demonstrate adequate clinical reasoning in relation to the in that it was inappropriate to select her as a service user for a demonstration kitchen assessment.

14. The matters set out at paragraphs 1-13 constitute misconduct and / or lack of competence.

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

Finding

Preliminary Matters

Application for parts of the hearing to be heard in private

1. Miss Deigan, on behalf of the Registrant, submitted that the entire hearing should be conducted in private on grounds of health, under Rule 10(1)(a) of the Health and Care Professions Council (Conduct and Competence Committee) (Procedure) Rules 2003 (“the Rules”). She submitted that whilst ordinarily matters could be separated between public and private, there was a danger that the Registrant’s evidence would not be his best in this hearing if he were required to go back and forth between public and private session.

2. Mr D’Alton, on behalf of the HCPC, objected to the entire hearing being conducted in private. He submitted that the evidence relating to the Registrant’s health and private life should be conducted in private, but that the rest of the proceedings should be heard in public.

3. The Panel accepted the Legal Assessor’s advice and consulted the HCPTS Practice Note on “Conducting Hearings in Private”.

4. The Panel determined that the parts of the hearing pertaining to the Registrant’s private life and health should be considered in private, in accordance with the Rules.

Background

5. The Registrant is, and was at the relevant time, registered with the HCPC as an Occupational Therapist.

6. The Registrant was employed by the Cambridge and Peterborough NHS Foundation Trust (‘the Trust’) from February 2005 until March 2017. The Registrant was employed as a Band 6 Occupational Therapist working in the Trust’s Inpatient Rehabilitation department.

7. In 2015 the Trust underwent a restructure and a number of separate teams (neighbourhood team, community nurses, occupational therapists, and mental health workers) were formed.

8. In November 2015 an informal performance investigation was commenced, looking into the Registrant’s record-keeping, duty of care, collaborative working, communication, patient safety, and professionalism. This informal investigation progressed to a formal investigation in May 2016 and was subsequently referred to the HCPC. The Trust dismissed the Registrant in March 2017. The Registrant appealed the Trust’s decision but it was subsequently agreed that the Registrant could leave his position on the grounds of ill health in July 2017.

9. In November 2018 the Registrant appeared before a panel of the Conduct and Competence Committee of the HCPC. The Allegation set out at the commencement of this determination was found proved in its entirety, save for Particular 2.

10. The substantive panel found that Particulars 1(a), 1 (b), 4, 5(a), 5 (b), 6, 7(a), 7(b), 8, 9(a), 9 (b), 10, 11(a), 11(b), 12(a), 12 (b) and 12 (c) each amounted to misconduct, and that particulars 3(a), 3(b), and 13 amounted to a lack of competence.

11. The matters found proved included failings in the Registrant’s record-keeping, his actions following assessments of patients’ needs, his communication with colleagues, and his clinical reasoning. The substantive panel heard and found proved that the Registrant had not achieved the required levels of competence with record-keeping, communication, clinical reasoning, and interpersonal relationships, including poor quality and sometimes inaccurate information handed over to colleagues. It was found that the Registrant consistently failed to take responsibility for himself and was unable to effectively manage his own time.

12. The substantive panel concluded that the Registrant’s conduct was remediable. However, that panel was not convinced by the Registrant’s assertion that he had now developed the requisite skills as a result of a course he had taken just two weeks prior to the substantive hearing. Nor was the substantive panel persuaded that the Registrant’s role as a Healthcare Assistant had required him to implement this learning to the same standard as that required of an Occupational Therapist.

13. The substantive panel was not satisfied that the Registrant had developed any insight into his failings in relation to clinical reasoning and his inability to make the judgments required when making a clinical decision. The substantive panel was concerned about his lack of insight into the impact of his actions, or inactions, on the Trust and service users. The substantive panel was concerned that despite the Trust’s support, the Registrant still associated his conduct and competence with his working environment. The conclusion reached was that the Registrant’s failings were highly likely to reoccur.

14. The substantive panel concluded that the Registrant’s fitness to practise was impaired both on grounds of public protection and on grounds of the wider public interest.

15. The substantive panel concluded that a Conditions of Practice Order for a period of 18 months was the appropriate sanction.

16. The Conditions of Practice Order imposed was as follows:

The Registrar is directed to annotate the Register to show that, for a period of 18 months from the date that this order comes into effect (“the Operative Date”), you, Stephen Morgan, must comply with the following conditions of practice:

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

2. You must inform the HCPC, within 7 days, of any disciplinary proceedings taken against you by your employer.

3. 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).

4. You must confine your professional practice to that of a Band 5 Occupational Therapist.

5. You must place yourself and remain under the supervision of a workplace Occupational Therapist supervisor at Band 6 or above registered with the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up a position as an Occupational Therapist. You must attend upon that supervisor and follow their advice and recommendations.

6. 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) Clinical reasoning;
b) Record keeping;
c) Report writing;
d) Effective time management; and
e) Making referrals.

7. Within three months of taking up employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

8. 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.

9. 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.

10. You must produce a written reflective piece reflecting on the implications of the findings of the Panel, including an account as to how your actions impacted service users and their families, your colleagues, the Trust and the wider profession. The reflective piece should also demonstrate an understanding of collaborative working, effective communication and clinical reasoning. This should be submitted to the HCPC at least 28 days prior to any future reviewing panel.

Registrant’s evidence

17. The Registrant attended the substantive review hearing on 15 September 2020, and provided a reflective statement. At the very commencement of his evidence the hearing had to be adjourned due to problems with the Registrant’s internet connection. The hearing resumed on 30 September 2020, when the Registrant provided a second reflective statement and gave evidence before the Panel.

18. The Registrant told the Panel that he had been working as a Healthcare Assistant since October 2017, and that the last time he worked as an Occupational Therapist was in March 2016. He said he had been looking for work as an Occupational Therapist but had been unsuccessful, although he was determined to return to work in his profession when a post became available.

19. He said, in relation to Condition 3, it had been his understanding that the Condition would only come into effect if he secured a position as an Occupational Therapist. He admitted that he had not immediately informed his employers of the existence of his Conditions of Practice, but that he had now done this after the correct position had been explained to him by his legal representative.

20. The Registrant said that he had been told that he was doing well in his current employment. He had been permitted to stand in for senior health carers when they were not available. This had given him greater confidence, and he was now able to delegate decisions effectively and communicate positively with members of staff.

21. He asked to be given a continued opportunity to demonstrate his abilities as an Occupational Therapist.

Submissions

22. Mr D’Alton submitted that the Registrant’s fitness to practise remained impaired as the Registrant had not as yet returned to practice. He submitted that it would be appropriate to extend the current order for a further 12 months to enable the Registrant to develop his insight and remediate his failings. He put forward two suggested additional Conditions for the consideration of the Panel.

23. Ms Deignan accepted that the Registrant’s fitness to practise remained impaired, and that his insight was at the very early stages of development. She supported the request made by Mr D’Alton for an extension of the current order to enable the Registrant to develop his insight and remediate his failings.

Decision

24. The Panel accepted the advice of the Legal Assessor regarding the meaning of impairment and the criteria that should be taken into account when considering sanction. It took account of the HCPC Sanctions Policy.

25. The Panel concluded that the Registrant’s fitness to practise remains impaired. He had not practised as an Occupational Therapist at all since the imposition of the Conditions of Practice Order. The Panel recognised that the Registrant is making some progress. However, he has not remediated his failings, his insight is at an early stage of development, and it was the judgment of the Panel that there remains a high risk that he will repeat his failings if permitted to practise unrestricted. The Panel concluded that the Registrant’s fitness to practise remains impaired on public protection grounds. It also concluded that the public interest demands a continued finding of impairment to uphold standards and confidence in the profession and its regulator.

26. The Panel agreed with the aggravating and mitigating factors that were found by the substantive panel:

Aggravating:

• repeated failings in relation to a number of separate service users over a significant period of time;

• a failure to comply with important timescales which were there to safeguard vulnerable service users;

• evidence of actual and potential physical and emotional harm to particularly vulnerable service users.

Mitigating:

• no previous disciplinary record in his career as an Occupational Therapist;

• personal circumstances, related to his health, that may have impacted upon his ability to work to the required standard;

• a challenging time at work in which the team was supported by a number of locum staff; and

• some remorse shown by the Registrant.

27. The Panel concluded that to take no action or to impose a Caution Order would be insufficient in light of the seriousness of the allegation.

28. The Panel concluded that a Conditions of Practice Order remained the appropriate and proportionate order in the circumstances, and that an extension of 12 months would be sufficient to enable the Registrant to develop the necessary insight and to remediate his deficiencies.

29. The Panel decided that it would be appropriate to add one further condition to the existing order, which would now become Condition 11.

30. Accordingly the Panel varied the Conditions of Practise Order and extended it for a period of 12 months.

Order

The Registrar is directed to vary the Conditions of Practice Order against the registration of Mr Stephen G Morgan for a further period of 12 months on the expiry of the existing order. The Conditions are:

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

2. You must inform the HCPC, within 7 days, of any disciplinary proceedings taken against you by your employer.

3. 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).

4. You must confine your professional practice to that of a Band 5 Occupational Therapist.

5. You must place yourself and remain under the supervision of a workplace Occupational Therapist supervisor at Band 6 or above registered with the HCPC and supply details of your supervisor to the HCPC within 14 days of taking up a position as an Occupational Therapist. You must attend upon that supervisor and follow their advice and recommendations.

6. 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. Clinical reasoning;
b. Record keeping;
c. Report writing;
d. Effective time management; and
e. Making referrals.

7. Within three months of taking up employment as an Occupational Therapist you must forward a copy of your Personal Development Plan to the HCPC.

8. 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.

9. 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.

10. You must produce a written reflective piece reflecting on the implications of the findings of the Panel, including an account as to how your actions impacted service users and their families, your colleagues, the Trust and the wider profession. The reflective piece should also demonstrate an understanding of collaborative working, effective communication and clinical reasoning. This should be submitted to the HCPC at least 28 days prior to any future reviewing panel.

11. You must produce evidence of any relevant CPD and Return to Practice training you have undertaken. This should be submitted to the HCPC at least 28 days prior to any review.

Notes

The order imposed today will apply from 22 October 2020.

This order will be reviewed again before its expiry on 22 October 2021.

Hearing History

History of Hearings for Mr Stephen G Morgan

Date Panel Hearing type Outcomes / Status
30/09/2020 Conduct and Competence Committee Review Hearing Conditions of Practice
15/09/2020 Conduct and Competence Committee Review Hearing Adjourned part heard
25/03/2019 Conduct and Competence Committee Final Hearing Conditions of Practice
26/11/2018 Conduct and Competence Committee Final Hearing Adjourned part heard
15/06/2018 Conduct and Competence Committee Final Hearing Hearing has not yet been held