Ms Beth Bowen

Preliminary Matters

Service

1. No issues of Service of the Notice of Hearing or other documents was raised. The Registrant was present and was represented by Ms Jane Lang of Counsel. The HCPC was represented by Ms Maryam Khorassani.

Background

2. On 18 January 2021 the HCPC received a referral from Cardiff and Vale University Health Board in respect of the Registrant, a Speech and Language Therapist, who had been subject to a disciplinary hearing held on 14th, 17th and 23rd December 2020. The hearing arose following a serious incident investigation in respect of a patient.

3. Initial concerns were raised in 20 June 2016, following a departmental audit when concerns were raised in respect of the Registrant’s record keeping and assessment of dysphagia patients. There then followed a period of improvement in the Registrant’s practice although the improvements were not sustained.

4. In June 2018 a capacity and demand exercise was carried out and identified that the Registrant was working well below capacity.

5. In December 2020, the findings of the disciplinary hearing were that the Registrant failed to carry out a comprehensive dysphagia assessment on a patient and discharged him; did not assess a patient within the recommended RCSLT timescales, and her assessment was not in line with the Clinical Management Framework for Dysphagia; her method of clinically assessing patients was not consistent with the Clinical Management Framework for Dysphagia document which was the standard operating procedure used within the Adult SLT Service and she was not meeting the standards required of her in her role as a Band 7 Senior Specialist Speech and Language Therapist in dysphagia and as a registered health care professional; her caseload management did not meet the standards expected as a Band 7 Senior Specialist SLT; her case notes did not meet the standards expected and did not follow the guidance set out in the Acute Dysphagia Management Pathway contained within the document Clinical Management Framework for Dysphagia in respect of 13 sets of case notes.

6. The disciplinary panel also considered an allegation that the Registrant’s failure to assess a patient within the recommended RCSLT timescales and failure to carry her assessment in accordance with the Clinical Management Framework for Dysphagia may have contributed to a catastrophic choking episode on 28.11.2018. The Coroner’s Inquest in relation to this patient’s death is due to take place on 21 September 2021.

7. On 23 December 2020 the Registrant was issued with a final written warning. In addition, it was recommended that the Registrant undertake a period of return to practice; undertake supervised practice and mentoring as agreed by the Professional Head of SLT in accordance with the relevant competency framework; commence an informal capability action plan; attend re-training in the electronic case note system; attend further training in dysphagia; attend training/learning regarding documentation standards and recording and undergo monthly audit compliance; did not return to Mental Health Services for Older People and should instead work within a supported structured team environment and submit a reflection on her practice within a specified time period. Additional concerns were raised by the disciplinary panel regarding an appearance of a lack of reflection on her practice, lack of insight, and the time that it took the Registrant to acknowledge this during the hearing.

8. Ms Khorassani submitted that an Interim Order remained necessary both for the protection of the public and was otherwise in the public interest. She further submitted that the Registrant had complied with the Interim Conditions of Practice Order and that conditions 7, 8 and 10 had been fulfilled and were no longer necessary. Ms Khorassani also submitted that the weekly supervision meetings could be relaxed from weekly meetings to fortnightly until the next review of this order in November 2021.

9. Ms Lang, on the Registrant’s behalf, agreed that the Interim Conditions of Practice Order was working and remained the proportionate response to the concerns raised. She submitted that the current order should be varied so as to delete conditions 7, 8 and 10. Ms Lang also submitted that the current requirement for weekly supervision meetings between the Registrant and her supervisor ought to be relaxed to monthly intervals.

Decision

10. The Panel has considered the submissions of Ms Khorassani and Ms Lang. In addition the Panel has accepted the advice of the Legal Assessor and has considered the HCPTS Practice Note on Interim Orders.

11. The Panel was of the view that the allegations remain very serious and demonstrated a history of concerns about the Registrant’s practice over a prolonged period of time. The Panel considered that there had been no change in circumstances which undermined the need for an Interim Order to protect the public and was otherwise in the public interest.

12. The Panel was of the view that interim conditions of practice remained the appropriate order to address the issues identified. The Panel considered that it was appropriate and proportionate to delete the current conditions 7,8 and 10 which are no longer necessary. In respect of the frequency of supervision meetings, the Panel determined to keep those at weekly intervals until the next review in November 2021, given that is the preference of the Registrant’s current supervisor.

ORDER: The Registrar is directed to add the following interim conditions of practice to the Registrant’s entry on the Register:

1. You must not deviate from the protocol for Dysphagia practice, followed by the Speech & Language Therapy service within which you work unless given formal written permission from your Supervisor.

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

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

4. 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).

5. You must place yourself and remain under the supervision of a clinical supervisor registered by the HCPC as a Speech & Language Therapist and supply details of your supervisor to the HCPC within 2 weeks of the Operative Date. You must attend upon that supervisor as required and follow their advice and recommendations.

6. You must confine your practice to a supported and structured Speech & Language Therapy team environment.

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

This order will be reviewed by the Committee no later than 30 November 2021 or earlier if new evidence which is relevant to the Order becomes available after it was made.

History of Hearings for Ms Beth Bowen