Miss Rebecca Holden

Profession: Occupational therapist

Registration Number: OT70032

Interim Order: Imposed on 13 Feb 2019

Hearing Type: Final Hearing

Date and Time of hearing: 10:00 26/04/2021 End: 17:00 04/05/2021

Location: This hearing will take place virtually

Panel: Conduct and Competence Committee
Outcome: Caution

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Allegation

Whilst registered with the Health and Care Professions Council as an Occupational Therapist:

1. You breached professional boundaries in that you:
a) Sent Patient 1 text messages which were inappropriate, in that they:
i. Were sent after you left the employment of Cheswold Park Hospital on or around 07 November 2018;
ii. Included 'x's;
iii. Encouraged Patient 1 to keep your communications secret;
iv. Indicated that you saw your relationship with him as a personal one;

2. You did not organise a Public Protection Unit (PPU) meeting regarding Patient 2 accessing swimming baths.

3. You were late in submitting Care Programme Approach (CPA) reports in respect of the following patients:
a) Patient 3
b) Patient 4
c) Patient 6
d) Patient 7
e) Patient 8
f) Patient 17
g) Patient 23

4. You did not review and/or update Care Plans in respect of the following patients:
a) Patient 10
b) Patient 11
c) Patient 12
d) Patient 13
e) Patient 14
f) Patient 15
g) Patient 16

5. You did not review and/or update Patient Access Forms in respect of the following patients:
a) Patient 7
b) Patient 10
c) Patient 11
d) Patient 12
e) Patient 13
f) Patient 14
g) Patient 15
h) Patient 16
i) Patient 17
j) Patient 18
k) Patient 19
l) Patient 20

6. The matters at paragraph 1 above amount to misconduct.

7. The matters at paragraphs 2-5 above amount to 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

1. Before the case was opened by the Presenting Officer three preliminary matters were decided by the Panel, namely:

• The HCPC’s application to amend the factual particulars of the allegation.
• The question of whether elements of the hearing should be conducted in private.
• Whether the Panel should first make and announce its decision on the facts before proceeding further with the case.

The application to amend the factual particulars

2. The HCPC sought to amend factual particulars to make certain corrections. These included the correction of the patient concerned in particular 2 (the allegation as originally referred contended that it was Patient 1) as well as correcting the identity of patients relevant to particular 3. Notice of this proposed amendment had been given to the Registrant and no objection to the application was made by her or on her behalf. There was also a typographical error in particular 7 which referred to paragraphs 2-6, but which should have been 2-5. The Panel was satisfied that the amendments were appropriate in the sense that they accorded with the evidence contained in the HCPC’s evidence, and also that there would be no prejudice to the Registrant if the amendments were to be permitted. Accordingly, the Panel acceded to the HCPC’s application. The allegation as set out above is as amended.
Elements of the hearing to be conducted in private

3. It was apparent from the Registrant’s witness statement provided to the Panel in advance of the hearing that she would give evidence about aspects of her health and of events that occurred in her private life during the period of employment relevant to the allegation. Accordingly, at the outset of the hearing the parties asked the Panel to make a ruling in principle that any evidence touching on the Registrant’s health or personal circumstances might be given in private. The Panel acceded to this application on the basis that it was necessary to protect the private life of the Registrant. In the event, aspects of the evidence received by the Panel were treated as private.

Number of stages to be undertaken by the Panel

4. The Panel considered that this is a case in which there were factors that made it desirable for it to initially make its decisions on the facts and announce those decisions before proceeding to consider any further stages that might be required to be considered in the event that facts were found to be proven.

5. When invited to respond to the allegation, on behalf of the Registrant, Ms Lambert stated that particular 1 was admitted in full (although it was said that the context would be explained), but particulars 2, 3, 4 and 5 were all denied.

Background

6. The Registrant graduated with a degree in Occupational Therapy in 2014 and was registered with the HCPC as an Occupational Therapist (hereafter “OT”) in the same year. From 2014 until May 2018 she worked as an OT in the housing equipment and adaptations department of a local authority. In early 2018 the Registrant uploaded her curriculum vitae onto a recruitment website, and having done so was contacted and told that she had been invited to a visit and interview at Cheswold Park Hospital (hereafter “the Hospital”). She accepted the invitation and visited the Hospital where she was shown around by the Head of Workforce. Although she did not believe that a formal interview had taken place, the Registrant was subsequently telephoned and offered a post as a Band 6 Senior OT. The basis of the appointment was that it was subject to a six month probationary period, with reviews being expected after one month, three months and at the end of the six month probationary period. The Registrant commenced her employment at the Hospital on 2 July 2018.

7. All patients at the Hospital were detained under the Mental Health Act. The Registrant was responsible for two wards of patients with personality disorders. The wards for which the Registrant had occupational therapy responsibility were both low secure wards that supported patients with complex personalities who struggled to engage pro-socially in the community. In April 2018, approximately three months before the Registrant commenced her employment, Ms HP, was recruited as Head of Occupational Therapy at the Hospital. In that role Ms HP managed the Registrant.

8. It has already been stated that the Registrant’s employment was subject to reviews after one month, three months and six months. Reviews took place on 13 August 2018 and 5 October 2018. In the event the six month review was brought forward from about the end of 2018 to 7 November 2018, and at that review the Registrant was dismissed.

Decision on Facts

9. The HCPC called a single witness to give evidence before the Panel, namely Ms HP, an OT. As has already been stated, Ms HP commenced employment as Head of Occupational Therapy in April 2018, approximately three months before the Registrant started to work there. In addition to the oral evidence of Ms HP, the Panel was provided with a substantial body of documentary exhibits relevant to the various factual particulars it has to decide.

10. The Panel found Ms HP to be a credible and honest witness who did her best to assist the Panel. She gave her evidence clearly and in a balanced manner, stating when asked about something that she could not remember. Ms HP also conceded points in favour of the Registrant.

11. The Registrant gave evidence and produced a number of documents. The document most relevant to the present, fact-finding stage, is her witness statement dated 28 March 2021.

12. The Panel found the Registrant to be honest and open in her evidence. When she admitted a shortcoming, she did not seek to minimise her culpability or make excuses for it. The Panel found that she was a witness whose evidence it could accept.

13. The Panel accepted the advice it received from the Legal Assessor as to the way in which it should approach the making of its decisions. In particular, the Panel accepted that the burden of proving the facts rested on the HCPC to prove matters on the balance of probabilities. In deciding whether facts were proven the Panel had regard to all of the evidence, that is to say the evidence presented by both the HCPC and the Registrant and both the oral testimony and documentary exhibits.

Particular 1 – Breaching professional boundaries by sending text messages to Patient 1.

14. It is necessary to explain some background to the Registrant’s involvement with Patient 1. Patient 1 had been detained under the Mental Health Act following a criminal conviction and had a diagnosis of personality disorder. Shortly before she was dismissed from her employment, the Registrant, who had been accompanied by a support worker, escorted Patient 1 when it was necessary for him to leave the Hospital because of an acutely distressing event that had occurred in his family. Following her dismissal from her employment the Registrant sent a private message by Facebook Messenger to Patient 1’s mother, a message that she described as a “welfare check nothing more”. Having done so, she received a text message from Patient 1 who had obtained her telephone number from his mother.

15. Although it is not suggested by the Registrant that any of the messages recorded in the transcription at page D146 of the hearing bundle did not take place, the Registrant did give evidence to the Panel that what is included there is not complete. Nevertheless, the Panel is satisfied that the messages included each of the specific elements alleged in the sub-particulars were written by the Registrant. Both by reason of his detention and his recent experiences, Patient 1 was a vulnerable individual. Writing the messages, particularly after her professional involvement with the patient had ended, the Registrant’s actions were inappropriate and constituted a serious breach of proper professional boundaries.

16. Having carefully considered all of the evidence the Panel has concluded that in communicating with Patient 1 in this way, she did so because the early termination of her employment left her with a sense that there was unfinished business with the patient, and she acted through a sense of misplaced and inappropriate empathy. The Panel is satisfied that she did send the messages to Patient 1 in a personal capacity. She explained to the Panel that it was her habit to end text messages with Xs, and their inclusion in the messages to Patient A did not represent an amorous intent. That the Registrant’s motivation was no greater than the misplaced empathy already mentioned is, in the view of the Panel, supported by the fact that the messages occurred over only one day and after that day there was no further contact.

17. The Panel finds that the Registrant’s admission of Particular 1 was appropriately tendered. Particular 1 is proven.

Particular 2 – Not organising a Public Protection Unit meeting with regard to Patient 2.

18. The issue of a Public Protection Unit (hereafter “PPU”) meeting arose in the context of a proposal that Patient 2 should be permitted to attend a swimming baths. The Registrant was requested to prepare a risk assessment, and it was also necessary for her to liaise with other parties whose input was relevant to the issue.

19. That a PPU meeting did not take place is not in issue. The Panel has concluded that it would not be satisfactory to decide the particular simply on that basis, believing that in the context of an allegation that this is an issue that could potentially amount to misconduct and/or lack of competence, it would be necessary to find that there had been a failure to arrange one arising from a duty to do so.

20. The documents presented to the Panel demonstrate that the Registrant had taken steps to progress the matter, and the Panel accepts that the emails presented to it do not represent all of the steps she was taking. Furthermore, the Panel accepts that a Police Officer, Det. Sgt. A, whose involvement was required, was on leave at a material time. The conclusion of the Panel is that it accepts the Registrant’s evidence that the point for arranging the meeting was never reached. In any event, it was not the Registrant’s sole responsibility to organise the meeting.

21. Accordingly, the Panel finds that particular 2 is not proven.

Particular 3 – Late submission of Care Programme Approach reports.

22. The HCPC’s case is that the Registrant was late in submitting the Care Programme Approach (hereafter “CPA”) reports in respect of the seven patients identified in sub-particulars (a) to (g).

23. The Panel considered that the first decision to be made was to decide when a report could be considered to be “late”. The Panel found that there was a lack of clarity in the case advanced by the HCPC on this issue. A documentary exhibit (bundle page D94) listed in tabular form the names of the some (but not all) of the patients included in the sub-particulars, the dates of the CPA meetings for which the report was required and a column headed, “All reports due by”. The dates in this last mentioned column are three weeks before the date of the CPA meeting. The Registrant accepted that she was sent this schedule when she commenced her employment. However, the Panel concluded that it could not properly proceed on the basis that there was a clear requirement that the Registrant should produce CPA reports three weeks before the date of the meeting for a number of reasons. One is that it was the evidence of HP that reports were often not provided three weeks before meeting, not only by the Registrant but also by other members of staff, yet they were not chased for them. Furthermore, it was the evidence of Ms HP that, “The normal timescale for submitting a CPA report under the Hospital Policy is either 10 days or 2 weeks before the actual review meeting takes place.” (witness statement paragraph 51). The uncertainty on the part of Ms HP as to whether it was 10 days or 2 weeks was explained by the fact that she had long since left her employment at the hospital and did not have access to documents that would have enabled her to clarify which period was required. It was the evidence of the Registrant (evidence accepted by the Panel as truthful) that at her induction she was told it was “10 to 14 days” before the meeting that the report should be submitted. Given these different elements of the evidence the Panel has concluded that the only realistic and fair approach that can be given to the word “late” in particular 3 is that a report would be late if not submitted 10 days before the date of the meeting.

24. Applying the finding that a report would be late if not submitted 10 days before the date of the meeting, the Panel turned to consider the dates of submission in respect of the seven patients relevant to this particular. Having done so the Panel did not find that any of the reports were late. In reaching this finding the Panel did not overlook the fact that in her witness statement the Registrant expressed an admission in relation to Patients 17 and 23. The report in relation to Patient 17 is dated 24 August 2018, and that in relation to Patient 23, 19 September 2018. However, as the “All reports due by” for these two patients at bundle page D145 were, respectively, 22 August 2018 and 9 September 2018, and the Panel infers that these dates were three weeks before the dates of the meetings. That being so, the reports were not later than 10 days before the dates of the meetings. For the avoidance of doubt, the Panel accepts the suggestion made by the Registrant that the stated meeting date of 23 September 2018 for Patient 3 is a typographical error as the meeting went ahead yet the report is dated 16 October 2018. The Panel was told that none of the meetings in respect of these patients were postponed or cancelled.

25. Accordingly, the Panel finds that particular 3 is not proven.

Particular 4 – Failing to review and/or update Care Plans.

26. The HCPC’s case is that the Registrant failed to review and/or update Care Plans in respect of the seven patients identified in sub-particulars (a) to (g).

27. The Panel has reviewed the patient documentation and has concluded that although there are relevant OT entries during the period of the Registrant’s employment, none of them were made by the Registrant herself. Rather, they appear to have been made by a range of health professionals including OT Assistants working under the direction of the Registrant. However, the Panel accepts that the Registrant was present at MDT meetings and that she was physically present when the OT Assistants made the entries. In these circumstances the Panel does not feel able to conclude that the Registrant failed to “review” the Care Plans.

28. Different considerations apply, however, to the question whether the Registrant updated the Care Plans. The contention contained in this particular is not that the Care Plans were not updated, rather it is that the Registrant did not do it. In circumstances where there are no entries made by the Registrant, the Panel has concluded that the Registrant did fail to update the Care Plans.

29. Accordingly, particular 4 is proven in relation to updating.

Particular 5 – Failing to review and/or update Patient Access Forms.

30. The HCPC’s case is that the Registrant failed to review and/or update the Patient Access Form (hereafter “PAF”) in respect of the twelve patients identified in sub-particulars (a) to (l).

31. PAFs were used within the hospital to identify the level of access that a patient should be permitted to have within the hospital. This would be relevant to issues such as where the patient would be allowed to go and the equipment the patient would be permitted to use.

32. The Registrant does not maintain that she reviewed or updated any of the PAFs identified in the sub-particulars, and the Panel finds that that accords with the documentary evidence provided by the HCPC. The Registrant’s denial of the particular is based on her belief that the obligation to address the issue of a PAF only arose if new information or exceptions arose.

33. The Panel is satisfied that the Registrant’s understanding of the circumstances that would require a PAF to be reconsidered is incorrect. The face of the “Occupational Therapy Access Forms” contains the statement, “Forms should be reviewed every 2 months and every time access changes” directly below where space is provided for the signature by the OT and by a member of the MDT. In these circumstances the Panel is satisfied that there was a clearly expressed requirement that the form should be reviewed every two months.

34. The fact that the Registrant did not review or update the PAFs in circumstances where she should have done every two months in the period of her employment which lasted for a little over four months has the consequence that particular 5 is proven.

Summary

35.The Panel therefore finds particulars 1, 4 (in respect of updating) and 5 to be proven, and it is therefore necessary to proceed to consider whether these particulars result in a statutory ground of misconduct and/or lack of competence being made out. If a statutory ground is made out it will be necessary for the Panel to go on to consider whether the Registrant’s fitness to practise is currently impaired. Although these two stages will be considered separately and sequentially by the Panel, submissions will be invited from the parties in relation to both.

Decision on statutory grounds

36. The task for the Panel is to decide whether the proven particulars amounted to the statutory grounds alleged. The Panel kept in mind that the structure of the allegation referred to the Conduct and Competence Committee was such that particular 1 could result in a finding of misconduct (but not lack of competence) whereas particulars 4 and 5 could result in a finding of either misconduct or lack of competence.

37. The Panel had regard to the submissions of the parties that were advanced after they had read the Panel’s written decision on the facts.

38. On behalf of the HCPC, the Presenting Officer made submissions as to the proper approach to the decisions that the Panel was required to make not only in relation to the statutory grounds, but also in relation to the issue of current impairment of fitness to practise.

39. On behalf of the Registrant, Ms Lambert also made submissions directed to the issues of the statutory grounds and current impairment of fitness to practise. She urged the Panel to have regard to a number of points when making its decisions. They included the following:

• The Registrant was experiencing difficulties at both home and work at the relevant time.
• The Registrant’s actions were neither deliberate nor premeditated.
• The Registrant had not sought to excuse her conduct, but had acknowledged shortcomings when she recognised them.
• No patient harm resulted of the Registrant’s actions.

40. Before turning to consider the specific proven particulars, the Panel identified a number of factors that it thought relevant to have in mind as contextual matters. They were:

• Before the Registrant’s employment at the Hospital the OT service there had been acknowledged to be dysfunctional. The reason for the appointment of Ms HP (approximately three months before the Registrant started) was for her to undertake a full review of the service and identify what needed to be done to improve the service. It is clear that problems persisted after the Registrant commenced including for example problems for other members of staff in completing records in a timely manner. The Panel noted that pre-existing members of staff complained to management about the Registrant’s keenness. Another factor was that Ms HP left her post after approximately 18 months, a factor in her departure being the resistance of pre-existing members of staff to the changes she sought to introduce.

• The Registrant had very limited experience of work of the type she was employed to undertake at the Hospital. Between her qualification and employment at the Hospital she had worked for a local authority in its housing, equipment and adaptation department. The only experience of work in a mental health setting was a six-week student placement at a unit for female patients with mental and personality disorders. The interview and induction process appears to have been very informal.

• During the period she was employed the Registrant was experiencing personal issues.

• The clear evidence of Ms HP was that no patient harm resulted from any of the Registrant’s failings. The Panel did not consider that this fact should result in the seriousness of them being minimised because there was potential for harm and it could be considered good fortune that they did not. However, it is fair to record the absence of harm which might otherwise have been an aggravating factor.

41. The Panel considered whether there was scope for particulars 4 and 5, whether singly or in combination, to result in a finding of lack of competence. The conclusion of the Panel was that they could not. All of the evidence received by the Panel satisfied it that the failures to perform the tasks that underpinned these findings did not result from a want of skills or knowledge. The Panel therefore found that it was appropriate to consider whether particulars 4 and 5 constituted misconduct or should be included in a finding of misconduct.

42. In order to decide whether a finding of misconduct should be made, the Panel first considered whether the particulars taken in isolation were sufficiently serious to be categorised as misconduct. If they were not sufficiently serious to amount to misconduct in isolation, the Panel then decided whether they could properly be included with other particulars to reach that finding. When making this decision the Panel considered whether there were any serious breaches of standards imposed by the HCPC on Registrants. As the Panel had already decided that this was not a case of lack of competence, the Panel focused on the Standards of conduct, performance and ethics.

43. The Panel first considered particular 1. The Panel has already stated that it accepted that this breach occurred as a result of misplaced empathy and because the Registrant had a genuine concern for the wellbeing of Patient 1. Nevertheless, the Panel was satisfied that personal communication to a patient who was vulnerable not only because of his diagnosed condition but also because of the recent emotional trauma was one that was so serious that fellow professionals would consider it to be deplorable. The Panel was satisfied that it was appropriate to describe it as misconduct.

44. So far as particular 4 was concerned, it is important to repeat the fact that the Panel found that the Registrant had reviewed the Care Plans. Her failing in this regard was in not personally updating the documents, in relation to some, but not all, of the patients allocated to her. In circumstances where the service was in a state of some disarray, the Panel has concluded that this was something that would be viewed as less than acceptable and reprehensible, but not deplorable. Accordingly, the Panel has concluded that particular 4 when viewed in isolation did not constitute misconduct.

45. With regard to particular 5, the Panel considered that the Registrant’s culpability was in not appreciating that the PAF form stated that up-dating was required every two months as it accepted her evidence that her belief at the time was that the updating was only required when a change of circumstances was demonstrated. The documentary exhibits included in the HCPC’s hearing bundle suggested that the Registrant might not have been alone in holding this view as there were examples of PAFs that were not updated for protracted periods both before and after the period of the Registrant’s employment. The failure to update a PAF had the potential to result in harm – it could have exposed individuals other than the patient to harm if a patient’s access was not restricted when it could have been, conversely it could have resulted in a patient being denied appropriate access that would have advantaged them. Nevertheless, as has already been stated, fortuitously no harm did materialise. Having regard to all the circumstances, the Panel concluded that this particular did not reach the misconduct threshold when considered in isolation.

46. Having decided that neither particular 4 nor particular 5 should be described as misconduct when considered separately, the Panel then considered whether it would be appropriate to aggregate them (or one of them) with particular 1 in an overall finding of misconduct. The conclusion of the Panel was that particular 1 was of such a different nature to the other particulars that it was not appropriate to include particulars 4 and 5 in the finding of misconduct.

47. The standards of the HCPC’s Standards of conduct, performance and ethics that the Panel found to be engaged in this case are the following:

Standard 1.7, “Maintain appropriate boundaries You must keep your relationships with service users and carers professional”.

Standard 2.7, “Social media and networking websites You must use all forms of communication appropriately and responsibly, including social media and networking websites.”

Standard 6.1, “Identify and minimise risk You must take all reasonable steps to reduce the risk of harm to service users, carers and colleagues as far as possible.”

Standard 9.1, “Personal and professional behaviour You must make sure that your conduct justifies the public’s trust and confidence in you and your profession.”

48. The result of these findings is that the Panel makes a finding of misconduct that is based upon particular 1 alone. Accordingly, it is that finding that must be taken forward for the consideration of current impairment of fitness to practise.

Decision on current impairment of fitness to practise

49. The task the Panel undertook was to decide if the misconduct arising from particular 1 is currently impairing the Registrant’s fitness to practise. In undertaking that task the Panel heeded the advice it received that was necessary to consider the personal and public components separately.

50. With regard to the personal component, the Panel made a number of findings that are relevant to the critically important issues of insight, remorse and remediation. They are:

• The Panel considers that the Registrant has demonstrated unusually high levels of insight. She has written five reflective pieces, one of which was provided to the Panel. Within that document the Registrant says “I felt that I had not only let myself and my family down but also my colleagues at the hospital where I was employed. My actions have jeopardised my career, my professional standing and the wellbeing, security and future of my family. My actions may have caused distress to patient one and his family. Whilst I felt I was acting in his best interest, I feel that I have let my own thoughts of concern and empathy towards the family and patient one overrule the consideration for what it may have been for patient one and his family.”

• The Panel has been told that the Registrant has booked some courses including: Safeguarding for Vulnerable Adults, level 3; Mental Health Awareness, level 1; Professional Boundaries in Health and Social Care, level 2.

• The level of insight is made even more clear by the Registrant’s statement that “During the time of my suspension I have had time to reflect on both myself personally and professionally. I feel that the suspension order was necessary and appropriate for me to act on developing my professional self. I feel that I had become lost and complacent with my role and allowed my own personal views spill over into my practice. It has helped me to recognise that whilst people I work with are in need, I cannot take action into my own hands. I have learned the importance of professional boundaries, supervision and professional development.”

• There have been numerous occasions on which the Registrant has expressed remorse, both in her written documentation and in her oral evidence. The Panel has no doubt that the remorse is genuine.

• The Panel had the benefit of a professional reference dated 27 April 2021 from a Senior Practitioner Occupational Therapist who has professional experience of the Registrant’s work and behaviour since 2014. In the reference she states that the Registrant “has always treated her clients and their carers with respect and dignity and provided appropriate support where necessary. She has always been honest and trustworthy in her professional practice. I am not aware of any inappropriate professional behaviour from my own experience of working with her. To my knowledge she has always respect client confidentiality in line with HCPC standards and current legislation.” The author of the reference goes on to say of the Registrant’s new role “She has only been in post for a couple of weeks but has conducted herself professionally during this time. She has been proactive with her induction and personal development plan for HCPC and is putting into action plans to achieve her goals.”

• In her oral evidence to the Panel, the Registrant explained how cautious she was being in her new role and the Panel accepted her assurance that she would fully respect professional boundaries in the future. In specific relation to professional boundaries, the Panel noted the Registrant’s current Action Plan which details what is expected of her, the planned actions and time scale.

• The Registrant has undertaken treatment to address health issues.

51. Applying all of these findings to the question whether the Registrant has remediated the failure demonstrated by particular 1, the Panel concluded that she had. The Panel concluded that the risk that the Registrant would repeat behaviour of that type was very low indeed.

52. For these reasons the Panel decided that upon consideration of the personal component, the Registrant’s fitness to practise is not currently impaired.

53. The Panel next considered the public component, in relation to which different issues are relevant. The very low risk of repetition has the consequence that the risk of future harm is not one that could require a finding of public component impairment of fitness to practise. Mention has already been made of the factors that resulted in the Registrant communicating with Patient 1 and of the difficult circumstances she was experiencing at that time, but notwithstanding those factors the Panel has concluded that a clear declaration is required that those communications were inappropriate. Not to make such a declaration would be to run the risk that public confidence in the OT profession would be diminished and there would be a risk that other practitioners would not be sufficiently reminded of the need to adhere to proper standards of behaviour even in the most challenging of circumstances. The Panel has reminded itself that there are circumstances in which it can be said that the finding of misconduct without the further finding of impairment of fitness to practise can be a sufficient marker of disapproval. However, after careful consideration, the Panel considers that the breach in this case is one that requires a finding of impairment of fitness to practise.

54. The finding that the Registrant’s fitness to practise is impaired in relation to the public component has the consequence that the Panel must go on to consider the issue of sanction.

Decision on Sanction

55. After the parties had an opportunity to read the Panel’s decisions on misconduct and current impairment of fitness to practise, they made submissions on sanction.

56. On behalf of the HCPC, the Presenting Officer made submissions on the proper approach to the making of a decision on sanction. He did not, however, urge the Panel to apply any particular sanction.

57. On behalf of the Registrant, Ms Lambert reminded the Panel that the Registrant had been subject to an interim order that had suspended her registration for a considerable period and latterly imposed restrictions of practice. She also identified those elements of the decisions already arrived at by the Panel that she submitted should mitigate any sanction, particularly the finding that there is a low risk of repetition with an associated absence of appreciable risk of future harm.

58. The Panel accepted the advice it received that a sanction should not be imposed in order to punish a registrant. Consistent with the decisions made by the Panel in this case the factors that are relevant to the sanction decision are the need to declare and uphold proper professional standards and the importance of maintaining a proper degree of public confidence in the registered profession. The Panel also accepted that it is necessary to pay heed to the HCPC’s Sanctions Policy. The Panel also accepted the advice that the first decision to make was whether the particular findings in the present case require the imposition of any sanction.

59. Understandably, the Sanctions Policy identifies abuse of professional position as one of the categories of “serious cases”. As the Panel has found that the misconduct was breaching professional boundaries, it paid close attention to paragraphs 67 to 75 inclusive of the Policy. The Panel found that the present case is not one that can fairly be described as one that fits with the circumstances identified in that section of the Policy. It is correct that Patient 1 was vulnerable, but that apart, the Registrant did not attempt to pursue an inappropriate relationship with Patient 1, her behaviour was not coercive or predatory and her motive in contacting the patient was not of a sexual or otherwise inappropriate nature. Accordingly, the Panel did not consider that the terms of the Sanctions Policy required it to treat this as a “serious case” for sanction purposes.

60. When the Panel addressed the question whether any sanction is required, it concluded the factors that resulted in the finding of the public component of impairment of fitness to practise necessitate the imposition of a sanction; public confidence would not be served and proper professional standards would not be upheld by passing from the case without imposing a sanction.

61. The Panel therefore next considered making a caution order. The Panel paid close attention to paragraphs 99 to 104 inclusive of the Sanctions Policy, and in particular to the bulleted points in paragraph 101. Although the Panel considers that all breaches of professional boundaries are serious, the breach that occurred in the present case can properly be said to have been limited. There is a very low risk of repetition, the Registrant has shown excellent insight and she has undertaken appropriate remediation. It followed from these findings that the Panel was satisfied that the present case is one that could properly result in the making of a caution order.

62. Before deciding that a caution order should be the outcome in this case, the Panel considered whether a conditions of practice order would be appropriate. There are two distinct reasons why it would not. One is that there would be no meaningful conditions of practice that could address the failing that underpinned the finding of misconduct, as there is already a clear and general prohibition on registrants contacting service users or former service users for non-professional reasons. More significantly however, is the fact that in the case of this particular Registrant it would be disproportionate to impose any condition of practice because she does not need to take any further steps in order for her to be permitted to practise without there being any further risk that she will fall short of expected standards.

63. The Panel therefore concluded that a caution order is indeed the appropriate sanction in this case. Having regard to all the relevant factors, including the Registrant’s efforts to rehabilitate herself since the events of late 2018, the Panel is satisfied that a caution order for a period of 12 months is sufficient. The Panel is satisfied that a fair-minded and fully informed member of the public would accept that such an order would be sufficient to mark the gravity of what occurred. This is particularly so given that the Panel has already described in paragraph 50 above the very strong mitigating factors for the Registrant which it has weighed in relation to the aggravating feature of this case which is the vulnerability of Patient 1.

 

Order

Order: That the Registrar is directed to annotate the register entry of Miss Rebecca Holden with a caution which is to remain on the register for a period of 1 year from the date this order comes into effect.

Notes

No notes available

Hearing History

History of Hearings for Miss Rebecca Holden

Date Panel Hearing type Outcomes / Status
26/04/2021 Conduct and Competence Committee Final Hearing Caution