Miss Becky Jones

Preliminary Matters

1. This is the second review of a 12-month Suspension Order that was imposed on 27 February 2020 on Miss Becky Jones (“the Registrant”).

2. The Order was extended for six months on 19 February 2021 and is due to expire on 26 September 2021. The Registrant has not attended this hearing, which has been conducted by video conference, nor has she been represented.

Service of Notice of Hearing

3. The certificate of the Registrant’s registration showed both a postal address and an email address for the Registrant. The Panel was satisfied that on 29 July 2021, a Notice of Hearing was sent to the email address of the Registrant.

4. The Notice informed the Registrant that this review of the current Suspension Order would take place today by video conference. Email confirmation that the email to the Registrant had been delivered was also received. There had been no response from the Registrant. The Panel was satisfied there had been good service of the Notice of Hearing to the registered email address of the Registrant.

Proceeding in the absence of the Registrant

5. On behalf of the HCPC, Mr Tarbert asked the Panel to proceed in the absence of the Registrant under Rule 11 of the Procedure Rules, and to take into account the HCPTS Practice Note on “Proceeding in the Absence of the Registrant”. The HCPC had also made an attempt to contact the Registrant via email on 17 August 2021 but received no response. Mr Tarbert submitted that it was in the public interest for this statutory review hearing to proceed. The Registrant had not engaged with the substantive hearing or the first review hearing and was voluntarily absent today. The Panel must balance the overriding interest of public protection with fairness to the Registrant.

6. The Panel considered the HCPTS Practice Note “Proceeding in the Absence of the Registrant”. There is a burden on a registrant to engage with their regulator. There is a statutory requirement for this Suspension Order to be reviewed before it expires. Public protection is an overriding factor to be considered. The Registrant had not requested an adjournment of the proceedings and she was not represented, nor did she engage with the substantive hearing or the previous review. It appeared to the Panel that the Registrant had deliberately and voluntarily chosen not to engage with today’s review hearing and it took the view that it was not likely the Registrant would participate in these proceedings on a future date if this hearing were to be adjourned. The Panel concluded that the fair and appropriate step was to continue the hearing in the absence of the Registrant.

Background

7. This is a Review Hearing under Article 30(1) of the Health Professions Order 2001, which requires the review of a substantive order prior to its expiry.

8. The Panel noted the background as stated by the substantive hearing panel in February 2020 and repeated by the reviewing panel in February 2021, namely that:

“The Registrant is an Occupational Therapist (“OT”) who was employed at Cheswold Park Hospital (‘the Hospital’) between September 2016 and January 2018. The Hospital is a forensic mental health hospital and includes medium-secure wards and low-secure wards.

The Registrant had a clinical caseload working with individuals held under the Mental Health Act 1983 with a diagnosis of mental illness and/or personality disorder. This was her first job as an OT in a forensic setting.

In or around January 2017, Patient B made a complaint about the Registrant. DW, a Quality and Compliance Director and Senior Manager at the Hospital, commenced an investigation. The original complaint made by Patient B was then withdrawn by Patient B, and a formal decision was made not to proceed any further with that allegation due to lack of evidence. However, in the course of the investigation additional concerns came to light regarding the Registrant’s professional boundaries with patients, which form part of this Allegation. DW conducted interviews with a number of hospital employees, including the Registrant herself. An Investigation Meeting was held on 8 February 2017, which the Registrant attended. At the conclusion of the investigation, a Management Report (“Management Report”) was produced by DW, dated 13 February 2017. This report made formal recommendations to address the issues raised.

…

In about November 2017, Patient A reported to a ward manager that the Registrant had used his bank card to withdraw money. An investigation into this complaint was undertaken by DW, which led to an Investigation Meeting on 14 December 2017, which the Registrant attended, followed by a Disciplinary Hearing on 5 January 2018, which the Registrant also attended.”

9. At the substantive hearing in February 2020, the panel considered an Allegation that had six factual particulars. One of those factual particulars was withdrawn at the beginning of the hearing. Another was found not proved. A third was found proved but did not amount to misconduct.

10. The substantive hearing panel concluded that the three remaining particulars could not amount to a lack of competence because they did not demonstrate a sufficient sample of the Registrant’s work. However, the substantive hearing panel concluded that those three remaining particulars each amounted to misconduct and formed the basis upon which the substantive hearing panel then decided that the Registrant’s fitness to practise was impaired. The substantive hearing panel’s findings on those three particulars were as follows:

Patient A

“In the Investigation Meeting, the Registrant admitted that she had used Patient A’s bank card and PIN number to withdraw money on behalf of Patient A. She said that she had done this on two or three occasions, although she could not remember when, and that it was a long time ago. She said that she had known that it was wrong to take out money on behalf of a patient, but that she “felt like I was trapped … I didn’t realise how dangerous he was and how manipulative he was”. She said that after the first time she had withdrawn money, Patient A told her that if she didn’t do it again, “he could get CCTV and he could get bank statements … and that I’d lose my job”.

…

The Panel accepted the admissions made by the Registrant in the Investigation Meeting and the Disciplinary Hearing that, at Patient A’s request, she made approximately three withdrawals from Patient A’s bank account using his bank card and PIN number, and gave the cash to him”

Patient B

“JL had worked therapeutically with Patient B. It was during one of these sessions in February 2017 that Patient B disclosed to her directly that he knew highly personal and sensitive information about the Registrant’s personal life.

CC explained that Patient B had directly told her that the Registrant had disclosed highly personal and sensitive information to him on another occasion.

Both witnesses were clear that the Registrant was not working therapeutically with Patient B on an ongoing basis because he was not on the ward that she was allocated to work on. From the oral evidence, the Panel found that the allocation of work to OTs was clearly defined, in that there was an identified OT working on each ward.

The Panel accepted the evidence of both these witnesses as to why the sharing of personal information with patients potentially placed the Registrant, other persons (such as other staff), and Patient B at risk. These witnesses explained that sharing such personal information with Patient B was a breach of professional boundaries.”

…

The Panel accepted JL’s evidence that on a date in January 2017, JL had walked past the kitchen and seen the Registrant and Patient B covered in flour from head to toe. It caused concern to JL to see the Registrant in the kitchen with Patient B, who was not her allocated patient, and she believed that such conduct was inappropriate by an OT (or any professional) in a forensic environment in the context of relational security. The Panel accepted the evidence of JL.”

The review on 19 February 2021

11. The previous reviewing panel stated that there was no evidence of engagement on the part of the Registrant. She had not engaged with the suggestions of the substantive hearing panel as to what helpful steps may be taken by her in respect of the review hearing.

12. There was no evidence of any material change in the Registrant’s circumstances. There was a persuasive burden on the Registrant to demonstrate that the risk of harm had been removed or, at least, reduced. The reviewing panel concluded that the Registrant’s fitness to practise still remained impaired on personal component grounds, because the Registrant had not provided evidence of the development of insight or adequate remediation to show that she would not cause a risk of harm to members of the public if she were permitted to return to unrestricted practice. The Panel also concluded that the Registrant’s fitness to practise remained impaired on public component grounds because members of the public would not have confidence in the profession or this regulatory process if the Registrant were permitted to return to unrestricted practice.

13. In considering the available sanctions, the reviewing panel considered the options in ascending order. The reviewing panel was dealing with examples of serious misconduct involving two patients, and the Registrant’s continuing failure to engage in these proceedings meant that it was not appropriate or proportionate to take no further action or to impose a caution order. The reviewing panel went on to consider a Conditions of Practice Order. However, where the Registrant had not engaged in the proceedings and where there was no information as to her employment circumstances, it was not possible to identify workable and effective conditions that would provide an adequate level of public protection. A Conditions of Practice Order was not appropriate.

14. The reviewing panel went on to consider an extension of the Suspension Order.

15. The reviewing panel recognised, from the substantive hearing decision, that the Registrant was given guidance in the workplace at Cheswold Park. There were, effectively, conditions placed on her practice in the workplace. However, the reviewing panel also recognised that it was likely that the Registrant had been working with patients with complex needs and there was no clear evidence as to how much prior experience the Registrant had in such a situation. The reviewing panel noted that in the workplace investigation the Registrant had said she felt manipulated by a particular patient. The mitigating factors identified within the substantive hearing decision included that the Registrant had only been in practice a short time and had shown the beginnings of limited insight into relational security and the building of professional boundaries. However, at the same time, the Registrant did not appear to seek guidance and support in the workplace. It appeared that she was not open with her employer and her misconduct was not limited to a single occasion.

16. Taking into account all of the above factors, and notwithstanding the past non-engagement on the part of the Registrant, the reviewing panel decided there was still potential for the Registrant to demonstrate to a future panel that she had developed insight into her past misconduct, recognised why that misconduct was not acceptable and, further, had taken remedial action to ensure that it would not be repeated. However, that all rested with the Registrant. There is a public interest in allowing occupational therapists to continue to practise provided they can show there would be no risk to members of the public. It may be possible for the Registrant to return to practice but that would happen only if the Registrant engaged constructively with this review process.

17. The reviewing panel took the view that, given there may be a possibility of the Registrant engaging in this process in the future, she ought to be given a further opportunity of demonstrating that she had learned from the past and had remedied her practice and behaviour. The reviewing panel concluded that an extension to the current Suspension Order was the appropriate and proportionate step. However, the reviewing panel stated it, “cannot emphasise clearly enough to the Registrant that it is largely in her own hands. If she wishes to return to practise as an Occupational Therapist, she has to take steps to show that she has learnt from the past and demonstrate there would be very little risk of her again committing misconduct. It may be that she sees a future in returning to practice but in a different practice area. If she does not engage in that way then it may be that at a future review hearing the outcome could be a Striking off Order.”

18. The reviewing panel stated that the next panel was likely to be assisted by the Registrant engaging in the review process by attending the hearing. This could be in person (if COVID-19 circumstances then permitted) or by telephone or video conference, providing evidence of reflection, insight, and learning and targeted Continuing Professional Development (looking at the past events of misconduct), references from other persons (whether or not in the field of Occupational Therapy) whether in connection with paid or unpaid / voluntary work, and giving a general account of her circumstances since the end of her employment at Cheswold Park.

Submissions by the HCPC

19. Mr Tarbert summarised the background of the case as recorded in the decisions of the previous panels. The HCPC position was that, given the failure on the part of the Registrant to engage, her fitness to practise was still impaired on the public and personal components. There was some evidence of insight and the Registrant’s misconduct was not in the most serious category, therefore at the substantive hearing in February 2020 the HCPC had submitted that a Striking Off Order would be disproportionate. At that hearing, the substantive hearing panel gave clear guidance on the steps required to be taken by the Registrant and the need for future engagement.

20. The reviewing panel in February 2021 also took the view that a Striking Off Order would be disproportionate, as submitted by the HCPC at that hearing. However, it was made clear that a Striking Off Order could be considered at the next review hearing.

21. Due to the lack of engagement since the last review and the absence of evidence of reflection or remediation, the HCPC submitted that a Striking Off Order would be appropriate today. The Registrant had not engaged with the suggestions of the previous panels as to what helpful steps may be taken by her in respect of this review hearing. There was no evidence of any material change in the Registrant’s circumstances. There was a persuasive burden on the Registrant. Mr Tarbert submitted that a Striking Off Order would be proportionate at this stage, in accordance with the guidance in the HCPC Sanctions Policy at paragraph 131.

Legal Assessor’s advice

22. The Panel is dealing with a review under Article 30(1) of the Health Professions Order 2001 and should take into account the HCPTS Practice Note “Review of Article 30 Sanction Orders”.

23. Article 30(1) provides that a Conditions of Practice Order or Suspension Order must be reviewed before it expires and that the reviewing panel may: extend or further extend the period for which the order has effect; make an order which could have been made when the order being reviewed was made; or replace a Suspension Order with a Conditions of Practice Order.

24. Any order made following an Article 30(1) review only takes effect from the date on which the order under review expires, so the Registrant must continue to comply with the expiring order until then.

25. The review process is not a mechanism for appealing against or ‘going behind’ the original finding that the Registrant’s fitness to practise was impaired. The purpose of a review is to consider whether the Registrant’s fitness to practise remains impaired and, if so, whether the existing order or another order needs to be in place to protect the public.

26. The key issue which needs to be addressed is what, if anything, has changed since the current Order was last reviewed. The factors to be taken into account include: the steps which the Registrant has taken to address any specific failings or other issues identified in the previous decision; the degree of insight shown and whether this has changed; the steps which the Registrant has taken to maintain or improve his or her professional knowledge and skills; whether any other fitness to practise issue have arisen; whether the Registrant has complied with the existing order and, if it is a Conditions of Practice Order, has practised safely and effectively within the terms of that order.

27. As is noted in the Practice Note, a reviewing panel’s task, “is to consider whether all the concerns raised in the original finding of impairment ... [have] been sufficiently addressed.” The decision in Abrahaem v GMC [2008] EWHC 183 (Admin) states there is a “persuasive burden” on a registrant to demonstrate at a review hearing that he or she has fully acknowledged the deficiencies which led to the original finding and has addressed that impairment sufficiently, “through insight, application, education, supervision or other achievement...”

28. The decision reached must be proportionate, striking a fair balance between interfering with the Registrant’s ability to practise and the overarching objective of public protection. Given that part of the Panel’s task is to assess whether the fitness to practise of the Registrant remains impaired, the Panel took into account the HCPTS Practice Note on “Finding Impairment” and noted the comments made by the substantive hearing panel when finding that fitness to practise was impaired.

Decision

29. The Panel accepted the advice of the Legal Assessor.

30. The Panel noted that there has been no engagement on the part of the Registrant with the HCPC. She has not engaged with the suggestions of the previous panels as to what helpful steps may be taken in respect of these review hearings.

31. There was no evidence of any material change in the Registrant’s circumstances. There was a persuasive burden on the Registrant to demonstrate that the risk of harm has been removed or, at least, reduced.

32. The Panel concluded that the Registrant’s fitness to practise remains impaired on personal component grounds. The Registrant has not provided evidence of the development of insight or adequate remediation to show that she would not cause a risk of harm to members of the public if she were now permitted to return to unrestricted practice. The Panel also concluded that the Registrant’s fitness to practise remains impaired on public component grounds, as members of the public would not have confidence in the profession or this regulatory process if the Registrant were permitted to return to unrestricted practice, as the Registrant has not engaged with her Regulator throughout this process. There was no evidence before the Panel that the Registrant has taken any steps to address the misconduct found proved by the substantive hearing panel.

33. The Panel concluded that an extension to the current Suspension Order was not appropriate because of her failure to engage with the regulatory process. Nothing has changed since this matter was before the reviewing panel in February 2021. Despite the advice of the previous panels and a further email from the HCPC sent to the Registrant on 17 August 2021, she has not engaged. The Panel noted that she is under a duty to cooperate with her Regulatory body and that the previous panels were careful to balance the interests of the Registrant and the public interest by affording her a clear opportunity to return to practice.

34. In considering the available sanctions today, the Panel considered the options in ascending order of gravity in accordance with the HCPC Sanctions Policy.

35. The Registrant’s serious misconduct (involving two patients) and her continuing failure to engage in these proceedings meant that it was not appropriate or proportionate to take no further action or to impose a Caution Order. The Panel went on to consider a Conditions of Practice Order. However, where the Registrant had not engaged in these proceedings and where there was no information as to her employment circumstances, it was not possible to identify workable and effective conditions that would provide an adequate level of public protection. A Conditions of Practice Order was therefore not appropriate.

36. The Registrant’s misconduct was a serious breach of the HCPC Standards of Conduct, Performance, and Ethics. She has failed to demonstrate adequate insight or remediation and she has now been out of practice for a lengthy period of time. In the Panel’s judgement, it is unlikely that she will remedy her failings in view of the opportunities to do so which she has not taken. Therefore, a further Suspension Order would be inappropriate.

37. The Panel noted paragraph 131 of the HCPC Sanctions Policy, which states:
“A striking off order is likely to be appropriate where the nature and gravity of the concerns are such that any lesser sanction would be insufficient to protect the public, public confidence in the profession, and public confidence in the regulatory process. In particular where the registrant:

• lacks insight;

…

• is unwilling to resolve matters.”

38. The only appropriate Order today, in accordance with paragraph 131 of the HCPC Sanctions Policy, was a Striking Off Order. A reasonable member of the public, in possession of all the facts, would not be surprised by the Panel’s decision that to impose a Striking Off Order today is both fair and proportionate, in view of the Registrant’s consistent failure to engage with the recommendations of previous panels and her lack of engagement again today.

39. The Panel therefore decided to impose a Striking Off Order.

The Registrar is directed to strike the name of Miss Becky Jones from the Register on the expiry of the existing order.

No notes available

History of Hearings for Miss Becky Jones